Full text of "Report of the Metropolitan Commissioners in Lunacy to the Lord Chancellor : presented to both houses of Parliament by command of Her Majesty"

o uu

V
V

J-

^ y^^^<

-^^--t^

^^^^^,

Boston Medical Library
\n the Francis A. Countway
Libraryof Medicine -Boston

Digitized by the Internet Archive

in 2010 with funding from

Open Knowledge Commons and Harvard Medical School

http://www.archive.org/details/reportofmetropolOOIond

K REPORT

METROPOLITAN COMMISSIONERS
IN LUNACY,

LORD CHANCELLOR.

PRESENTED TO BOTH HOUSES OF PARLIAMENT BY COMMAND
OF HER MAJESTY.

LONDON:

^ BRADBURY AND EVANS, PRINTERS, WHITEFRIARS.

1844.

f LONDON :

BRADBIRY AND EV^ANS, PRINTERS, WHITEFRIARS.

COMMISSIONERS.-1843 86 IS'l^.

LORD SEYMOUR.

LORD ASHLEY,

RIGHT HON. R. VERNON SMITH.

ROBERT GORDON, Esq.

COLONEL WILLIAM HENRY SYKES.

JAMES MILNES GASKELL, Esq.

JOHN BARNEBY, Esq.

FRANCIS BARLOW, Esq.

JAMES ROBERT GOWEN, Esq.

DOCTOR THOMAS TURNER.

DOCTOR JOHN BRIGHT.

DOCTOR HENRY HERBERT SOUTHEY.

DOCTOR JOHN ROBERT HUME.

DOCTOR THOMAS WATERFIELD.

DOCTOR FRANCIS BISSET HAWKINS.

DOCTOR JAMES COWLES PRICHARD.

JAMES WILLIAM MYLNE, Esq.

BRYAN WALLER PROCTER, Esq.

JOHN HANCOCK HALL, Esq.

R. W. SKEFFINGTON LUTWIDGE, Esq.

EDWARD DU BOIS, Clerk and Treasurer.

Office, 12, Abingdon Street^
Westminster.

TABLE OF CONTENTS.

PAGE

Preliminary Observations . . , • .

The different Classes of Lunatic Asylums, their ConstxTiction, Con-

dition, Management, and Visitation

County Asylums ......

County Asylums partly supported by Contributions .

Naval and Military Hospitals ....

Public Hospitals supported wholly or partly by Voluntary Contri

butions .......

Licensed Houses . . .

Abuses and Defects ......

Condition of Paupers on Admission

Fonns of Disease ......

102

Medical Treatment . . . . .

113

Diet

118

Classification of Lunatics .....

121

Occupation, Amusements, and Exercise

128

Restraint .......

137

Religious Services ......

. 159

On the Admission and Liberation of Patients

163

Statistics of Insanity ......

177

Criminal Lunatics ......

195

Wales ........

. 199

Suggestions for the Amendment of the Law

. 204

Appendix A. .

. 209

„ B

. 214

„ C. .

. 223

„ D. - . . .

. 236

„ E

. 244

„ F, sheet inserted at .

. 274

„ G

. 274

TO THE

LORD HIGH CHANCELLOR,

OF ENGLAND.

TITE, the Metropolitan Commissioners in Lunacy, beg

to submit to your Lordship the following Report,

relating to the several matters entrusted to our care.

As our duties have been materially increased, by

the provisions of the Act 5 & 6 Vic. c. 87, which have

enabled us to inspect the condition of the various public

and private Asylums throughout England and Wales,

beyond as well as within the limits of the Metropolitan

district, we think it right to report to your Lordship the

result of our experience, in a more minute and specific

way than we have heretofore been accustomed to do.

Your Lordship is aware that the legislative provi- Legislative pio-
p 1 J.- J. T i- A 1 • visions now m

sions now in force relative to Lunatic Asylums m force.

England, are for the most part comprised in the public

Acts of 9 Geo. IV. c. 40 ; 2 & 3 Will. IV. c. 107 ;

and 5 & 6 Vic. c. 87.

The Act 9 Geo. IV. c. 40, relates mainly to the for- 9 Geo. IV. c

mation and management of County Asylums ; and several

other Statutes have been subsequently passed, by means

of which various Lunatic Establishments, not originally

IV. c. 107.

erected for County purposes, have been brought within
the regulations of that Act. There are, however, several
other Asylums of a mixed character, supported wholly
or partially by charitable contributions, to which the
Act last referred to does not apply.

2 & 3 Will. The Act 2 & 3 Will. IV. c. 107, (enlarged and

continued by later Acts) relates to all licensed Lunatic
Asylums throughout England and Wales ; and directs
certain of the Metropolitan Commissioners (amongst
other things,) to visit the several licensed Houses
within the limits of the County of Middlesex^ and of
certain specified portions of Surrey and Kent, (which
limits are now known as the Metropolitan dis-
trict,) four times in each year, and to report to your
Lordship as to their condition. This Act also directs,
that three Justices, together with a Medical Attend-
ant, shall be appointed at the General Quarter Ses-
sions to visit all Houses Licensed for Lunatics, in
the various counties of England, three times in every
year,

5 & 6 Vic. c. The Act 5 & 6 Vic. c. 87, relates to all Lunatic

Asylums in England and Wales, whether private or
public, except to the Hospital of Bethlem ; and by this
Act certain of the Metropolitan Commissioners are di-
rected, twice a year, to visit and report on the Licensed
Asylums in the provinces, and once a year to visit and
report on the County and other Asylums regulated
under the Act of 9 Geo. IV. c. 40 ; and your Lordship
is also empowered to direct us to visit the Royal Mili-
tary and Naval Hospitals, and all other public Asylums
for the reception of insane persons in England and
Wales, except the Hospital of Bethlem. This power
your Lordship has thought proper to exercise, in order
that we might have a more complete opportunity of
ascertaining the present state of Lunacy in this Coun-
try, and of judging of the sufficiency of the existing
laws relating thereto. ^

87.

We have tlioiight it right to mention the general
purport of these Acts, as it will be necessary to advert to
some of them in subsequent parts of this Eeport.

The total number of Lunatic Asylums, public and Number of
private, which we have thus been authorized to visit, ^^ ""'^'
amounts to 166; viz.: —

17 County Asylums or Asylums brought within the
scope of 9 Geo. IV. c. 40., viz. :
12 County Asylums.
5 County and Subscription Asylums.
1 1 Asylums of a mixed character, maintained partly
by subscription and partly by income arising
from charitable foundations.
2 Military and Naval Hospitals.
99 Houses licensed by the Justices in Session ; viz. :
59 which receive private patients only.
40 which receive paupers as well as private
patients; of which, 4 are parts of
Workhouses.
37 Houses licensed by the Metropolitan Commis-
sioners ; viz. :

33 which receive private patients only.
4 which receive paupers as well as
private patients.

A list of Asylums, with the weekly charges for Appendix (A.)
pauper patients, and the number of patients in each
Asylum on the 1st January, 1844, will be found in
Appendix (A).

In addition to the Asylums above enumerate^, 4 Additional

XX 1 1 T iiiiTi- ' CI • Houses license

Houses have been licensed by the Justices m Session, ^^^^^ j^^^ j
and 3 by the Metropolitan Commissioners, since the 1844.
1st January, 1844.

The Asylums above mentioned, with the addition of
the Hospital of Bethlem, comprehend all the Asylums
for Lunatics in England and Wales, which are at
present expressly recognised by law.
b2

Division into
districts for
visitation.

Inquiries made
bv Commis-

Befoi'e entering into a more minute examination of
the subject, which it is our duty to bring before your
Lordship, we beg to state that in pursuance of the
7th section of the Act 5 & 6 Vict. c. 87, a Board
of the Metropolitan Commissioners was assembled,
at which the whole of England and "Wales was
divided into four districts ; regard being had to the
number of public and private Asylums necessary to
be visited, and also to the numbers of patients confined
therein ; and that each of these districts was again sub-^
divided into two parts, for the purpose of more
conveniently distributing the visitations amongst the
Legal and Medical Commissioners.

Throughout the course of the visitations, made in
pursuance of this arrangement, we have endeavoured to
carry into full effect the spirit as well as the letter of the
Acts of Parliament : and with this view, we have ex-
tended our inquiries to many subjects beyond those
which are specifically mentioned in those Acts. Our
experience within the Metropolitan district has suggested
some of these inquiries ; and we have also obtained in-
formation from intelligent persons acquainted with the
provincial Asylums, as to their general character and
management. It has been our endeavour to ascertain
the treatment to which the lunatic (particularly the pau-
per lunatic) has been subjected from the commencement
of his disease, previously to his reception in an Asylum,
to his final discharge. For this purpose, we have
visited various Workhouses and other places ; have
observed the condition of the inmates ; have learned
how and upon what principle the insane poor have
been removed thence to Lunatic Asylums ; to what
extent their comfort has been afterwards secured ;
how often and with what care they have been visited ;
what benefit they have derived from medical treatment ;
and what may be the impediments to, or facilities for
their liberation when they are restored to health. The

excellencies or defects in certain points which we have
found existing in some institutions, have instructed us
to direct our attention to the same points in others.

We have examined, minutely, into the manage-
ment of various Asylums, their resources, their secu-
rity, superintendence, and general arrangements, includ-
ing their domestic economy, and also their external
government and supervision : it being quite obvious
that many abuses and defects might exist undiscovered in
these establishments, if the mere condition and appear-
ance of each place, at the period of our visit, were admit-
ted as a su.fficient criterion of its condition, at all other
times and seasons. We have deemed it right to inspect
the clothing, bedding, and food, of the patients, and
to inquire into every circumstance connected with their
subsistence, comfort, and general management; more
especially in all establishments for paupers. We have
perused the Magistrates' reports, and have inquired
into the frequency of their visits, ^he nature and extent
uf the inquiries instituted by them, and the general
result of their investigations. We have examined all the
registers, with a view to ascertain, as much as possible,
the amount of intelligence and care exercised in reference
to Lunatic Patients, by the visiting Medical Officers ;
and we have also (as directed by the Acts) given our
attention to the questions of religious exercises, classifi-
cation, and restraint.

In addition to the foregoing subjects, we have, in
some instances, thought it advisable to make inquiries
as to the origin of the Asylum, and the funds out of
which it is supported ; as to the experience of the
Medical Attendant, his duties, and the remuneration
given to him ; as to the particular duties of the Matron,
and various attendants, and their wages ; as to the oppor-
tunities afforded of learning the previous history of
Patients, the mode of ascertaining their convalescence,
and of obtaining their discharge; as to the remedies

General state-
ment of condi-
tion of Asy-
lums.

Asylums for
lunatic poor,

filled with in-
curable patients.

employed, especially in the cases of dirty and helpless
patients ; as to the number of cures, deaths, relapses,
and other statistical matters, which will be hereinafter
specially referred to ; as to the Dietary, and the means
of adapting it to the exigencies of the disease ; and as
to various other points, involving the general comforts
of Lunatic Patients.

The Asylums thus brought before our view, ex-
hibit instances of almost every degree of merit and
defect. Some are constructed on an extensive scale,
and combine most of the advantages and comforts of a
wealthy establishment. Others are mean, poor, confined
within narrow bounds, and almost wholly without
comforts or resources of any kind. Some are situate
in open and healthy places, in the midst of large airing
grounds, and cheerful prospects. Others are in the centre
of towns or populous suburbs, without good air, and
without space sufficient for daily exercise. In some
places, books and amusements are furnished abundantly
for the benefit of Patients, and various means of occu-
pation, adapted to their capacities and previous habits,
are provided. In others, the Lunatic is left to pass his
time listless and unoccupied, or occupied only with the
delusions that disturb him, and which thus, being
diverted by no amusement or employment, in the course
of time become strengthened, and not to be removed.

The Asylums in which the lunatic poor are received,
have however been the subject of our most especial
enquiries. These places (even such of them as are
upon the most extended scale) are, we regret to say,
filled with incurable patients, and are thus rendered
incapable of receiving those whose malady might still
admit of cure. It has been the practice, in numerous
instances, to detain the insane pauper at the work-
liouse or elsewhere, until he becomes dangerous or
unmanageable ; and then, when his disease is beyond all
medical relief, to send him to a Lunatic Asylum where

he may remain during the rest of his life, a pensioner
on the public. This practice, which has been carried on
^r the sake of saving, in the first instance, to each pa-
rish some small expense, has confirmed the malady of
many poor persons, has destroyed the comfort of families,
has ultimately imposed a heavy burthen upon parishes
and counties, and has, in a great measure, nullified the
utility of public Lunatic Asylums, by converting them
into a permanent refuge for the insane, instead of hospitals
for their relief or cure. For years past, we have endea-
voured, within the Metropolitan District, to diminish this
evil practice; but it still prevails; and we doubt whether
it will be altogether suppressed, unless some plan be
adopted and enforced, for removing, from time to time,
each Lunatic as he becomes incurable from the Asylum
to which he has been sent, and supplying his place by
another whose case, from the recent nature of the attack,
may still admit of cure; and unless, also, there be a
strict and frequent supervision, not only of Asylums,
but of all Workhouses, and other places in which the
lunatic poor are detained. We beg to refer your Lord-
ship to the subsequent pages of this Report, for more
detailed information on this important point.

The number of insane persons ascertained to exist in Number of in
England and Wales, exceeds 20,000 ; and there is every England* and
reason to believe that this is considerably below the ^^^^s.
actual amount. They belong to every station in society;
but by far the largest proportion of them (exceeding in
fact two-thirds of the whole), are objects of charity, and Two thirds

. . , . , , ,. mi maintained at

are mamtamed entirely at the public expense. Ihese the public
unhappy persons are, for the most part, necessarily ^^pense.
removed from their homes, and consigned to the protec-
tion of a Lunatic Asylum, by their relations and friends.
We have, therefore, entered upon the discharge of our
duty, with a strong sense of the claims of the Insane
upon our vigilance and care. We are desirous, at the
same time, to do justice to those to whose charge the

Assistance ren-
dered by Medi-
( ill Officers and
Superintendents
of Asylums to
Commissioners.

Subject divided
into heads.

Insane are committed ; and, with this view, we beg
leave to bring before your Lordship's notice one class
of persons, who, in the course of our labours, have
rendered us the most cordial and valuable assist-
ance, — we refer to the resident Medical Officers and
Superintendents of the great public Institutions and
well-conducted private Asylums throughout the king-
dom. "We entertain a high opinion of the ability and
zeal with which these gentlemen devote themselves to
the performance of their arduous duties; and we feel
bound to state, that, although on many occasions we
have been compelled to impose upon them much
trouble, they have affi^rded us their assistance with the
utmost readiness.

After these preliminary observations, we proceed to
call your Lordship's attention to the present condition
of Lunacy in England ; and for the greater convenience
of shewing the result of our investigations, we shall
divide the subject into the following heads, viz. :

I. The different Classes of Lunatic Asylums, their

Construction, Condition, Management, and
Visitation.

II. Condition of Paupers, on Admission.

III. Forms of Disease, Medical Treatment, Diet,

and Classification.

IV. Occupations and Amusements.
V. Restraint.

VI. Religious Services.

VII. The Admission and Liberation of Patients.
VIII. Statistics of Insanity.
IX. Criminal Lunatics.
X. Wales.

THE DIFFERENT CLASSES OF LUNATIC ASYLUMS,
THEIR CONSTRUCTION, CONDITION, MANAGE-
MENT, AND VISITATION.

The distinctions which exist between the various Asylums df-
Lunatic Asylums in England, and the nature and extent classes.
of their accommodations, will be better understood, if
the Asylnms are divided into classes, and a brief enu-
meration is given of the principal points in which they
differ from each other. They may be divided into five
classes : —

First. — Coimty Asylums, which have been established County Asy-
under the the Acts of 48 Geo. III. c. 96, and 9 Geo. "™^'
TV. c. 40, and have been erected by Counties, and paid
for wholly out of County rates, for the reception
of Paupers ; but in some of which private Patients
have nevertheless been received. In this class, are
included the Asylums for the Counties of Bedford,
Chester, Dorset, Kent, Lancaster, Middlesex, Norfolk,
Suffolk, Surrey, and for the West Riding of the County
of York : in this class, also, may be included the Asylum
at Haverfordwest, St. Peter s Hospital, Bristol, and
the Workhouse at Hull, which have been declared
County Asylums under special Acts of Parliament.

Secondly. — County Asylums united with Subscrip- County Asy-
tion Asylums, which have been established under the 1"™^ united

•^ with Subscnp-

last-mentioned Acts, and have been erected by Counties tion Asylums,
and subscribers, and paid for partly out of County
rates, and partly by private subscription. In this class
are included the Asylums for the Counties of Cornwall,
Gloucester, Leicester, Nottingham, and Stafford.

Military and
Naval Hospitals

Public Hospi-
tals, &c. sup-
ported wholly
or in part by
voluntary con-
tributions.

Licensed
Houses ;

including parts
of certain
Workhouses.

Bethlem Hos-
pital not
included above.
Workhouses
not licensed,
containing
Lunatic wards.

Thirdly. — The Lunatic wards of the Royal Military
and Naval Hospitals, supported by, and under the
control of the Government.

Fourthly. — Public Hospitals, and parts of Hospitals
or other Charitable Institutions, supported wholly or
partly by voluntary contributions. Of this class are the
Lunatic Asylums at Exeter, Lincoln, and Northampton ;
the "Wanieford, (formerly called the Radcliffe,) at Oxford,
the Retreat at York, the York Asylum, St. Luke's
Hospital, the Bethel Hospital at Norwich, the Lunatic
ward of Guy's Hospital, the Hospital at Manchester,
and the Liverpool Asylum.

Lastly. — Licensed Houses, which receive Private
Patients only. Private and Pauper Patients jointly, or
Pauper Patients only. This class includes the licensed
parts of the following Workhouses, viz., the House of
Industry for the Isle of "Wight at Carisbrooke, the
Workhouse at Devonport, the Houses of Industry at
Kingsland near Shrewsbury, and at Morda near
Oswestry.

The Royal Hospital of Bethlem is not included in
the above enumeration.

Besides the several Asylums already described, there
are numerous Workhouses belonging to Parishes and
Unions, which are not licensed for the reception of the
Insane, but which, nevertheless, contain wards exclu-
sively appropriated to Lunatics, and receive large num-
bers of Insane persons, dangerous as well as harmless ;
such as the Workhouses at Birmingham, Manchester,
Sheffield, Bath, Leicester, Redruth, in Cornwall, the
Infirmary Bethel at Norwich, and others.

County Asy-
lums erected
under 48 Geo.
in. c. 96, and
9 Geo. IV.
c. 40.

1. County Asylums.

The existing County Asylums have been erected
under the provisions of the Acts of 48 Geo. III. c. 96,
and 9 Geo. IV. c. 40. The former of these Acts directs

the Visiting Justices to fix upon an airy and healthy
situation, with a good supply of water, affording
a probability of the vicinity of medical assistance,
and to provide separate wards, day rooms, and airing
grounds for males and females, and for the convales-
cents and incurables, and dry and airy cells. The Act
of 48 Geo. III., is repealed by the Act of 9 Geo. IV.
c. 40, except as to matters done before the passing of
the latter Act. This latter Act omits the directions as
to the site, and plans of Asylums ; but gives special
directions as to the contracts for the purchase of land,
and for the erection of County Asylums.

We made inquiries at the County Lunatic Asylums Contracts for
as to the mode in which contracts for the purchase of F"''?^'^"^,

, , ^ land tor build-

land tor the erection of buildings have been entered '"gs.

into, and carried into execution : but these contracts,
and all orders relating thereto, being directed to be kept
amongst the records of the different counties, we found
that scarcely any information upon the subject could
be obtained at the asylums. We have, however, pro-
cured the most accurate statements we could obtain of
the cost of the land, and the buildings of many of the
Asylums, and these, together with other particulars,
will be found in Appendix(B). Your Lordship will per- Appendix (B).
ceive from the perusal of these statements, that the
County Asylums which have hitherto been erected
have caused a heavy expense to the rate-payers, an
expense which we fear has prevented the increase of
these most useful establishments*. Although we have

* The Magistrates of tte North Riding of Yorkshire are about to
erect a County Lunatic Asylum for their Paupers. There are several
Corporate and Borough towns in the North Riding which are believed
to be desirous of uniting with the County Magistrates in the erecting
of their Asylum, but it has been considered that the Acts of 9 Geo.
IV. c. 40, and 5 & 6 Will. IV. c. 76, do not authorize such unions.
Our attention has been drawn to this subject by the Chairman of the
Quarter Sessions for th^ North Riding of Yorkshire ; and we think
that it is desirable that the Act of 9 Geo. IV. c. 40, should be
amended in this respect.

Comparative
cost of Union
Woikhouses
and Asylums.

Increase of ex-
pense by making
building fire-
proof.

Use of single
cells.

Doimitorics.

no wish to advocate the erection of unsightly buildings
we think that no unnecessary cost should be incurred
for architectural decoration ; especially as these Asylums
are erected for persons who, when in health, are accus-
tomed to dwell in cottages.

The best Union Workhouses have in general cost
not more than 40^., whilst Pauper Lunatic Asylums,
have, in some cases, cost upwards of 200^. per head,
for the persons whom they will accommodate. It is
true that Lunatics cannot be properly taken care of in
the manner in which paupers are provided for; and there
are many expensive arrangements essential to a Lunatic
Asylum, which are not required in a Workhouse. We
have been informed that nearly half the expense of
an Asyhim is caused by the number of separate cells, and
by making the building fire-proof; whereas if ordinary
dormitories, sufficiently large to contain a moderate num-
ber of patients, were principally used, and that part of
the house most exposed to danger only were made fire-
proof, a large proportion of the cost might be saved.

In reference to the question, whether many single cells
are necessary or not, we observe that the larger pro-
portion of patients in almost every County Asylum have
separate cells, whilst in almost all private Houses licensed
for paupers, single cells are rarely used, except for a few
of the more violent and dangerous inmates ; the general
body of the patients sleeping in dormitories containing
several beds, varying in number according to the size
of each room. In 1842, some of the corridors at StaflPord,
owing to the crowded state of the Asylum, were converted
into dormitories, and divided by folding partitions, which
allowed perfect ventilation when closed at night. At
Lincoln a large proportion of the patients' beds are
placed in galleries, an arrangement that is considered to
be advantageous, and in all the large County Asylums
there are some sleeping-rooms containing numbers of
beds. We have seldom seen any sleeping rooms for

paupers more comfortable, and more cleanly or better
ventilated, than some of the dormitories in the Licensed
Houses at Bethnal Green, Fairford, Devizes, and Market
Lavington, each of which contains seven or eight beds,
or more.
The dormitories in these and in some other licensed Comfoit and

. advantage of

Houses appear to us to possess every comfort which Dormitories,
the paupers either wish for or require. They, more-
over, better accord with the pauper s previous habits
than sleeping alone in a solitary cell with a single
window ; and the companionship of others in the same
room does not seem to interfere with their nightly rest.
"We rarely visit a licensed House containing paupers
without asking some of the patients how they sleep at
night, and we are generally answered that they sleep
well. These persons almost invariably occupy sleeping-
rooms containing several beds. In many good Licensed
Houses, also, private patients, of a superior class,
frequently sleep, to the number of four or five, or even
more, in separate beds in the same room. Upon the
whole, we are of opinion that dormitories containing
several beds are much preferable, as a general arrange-
ment, to cells or single-bedded rooms ; although a limited
number of the latter is doubtless necessary in every
large Asylum, for the use of violent, noisy, and mis-
chievous patients, and for such as are labouring under
a paroxysm of insanity. The introduction, however, of Great number
any great number of single cells in an Asylum is objec- objecUonaWe!
tionable, by reason of the space which they occupy, and
of the expense incident to their erection ; to which may
be added the circumstance of their small guarded win-
dows giving a gloomy character to the building. For,
when so much is in operation to afford cheerfulness and
remove restraint within, it may not be without advan-
tage to abolish the prison-like aspect which marks the
exterior of some of the old Asylums.

The question whether Lunatic Asylums for Paupers

Question
whether Asy-
lums forPaupers
should be fire-
proof.

Site and con-
struction of
County Asy-
lums.

Requisites
enumerated.

should be made fire-proof, has been brought under our
consideration, and is specially connected with the sub-
ject of the cost of these buildings. The Public Hospitals
for the Sick in London and in the country, and the large
Public Hospitals for the Insane, at Northampton, York,
Exeter, and elsewhere, are not built fire-proof; and of all
the private licensed Houses for the Insane, we know of
only two which have been so built.* The importance
of rendering the building fire-proof is obviously in-
creased if a large proportion of the patients sleep in
separate cells ; for, in the event of a fire, the difficulty
of unlocking a great many doors would much impede
the removal of the patients to a place of safety.

Having called your Lordship's attention to the ques-
tion of the cost of County Asylums, we now proceed to
remark on the site for such buildings, and on what is
necessary in their construction, in order to render them
fit for the reception of Lunatics.

An Asylum should be placed upon elevated ground,
and should command cheerful prospects: the soil
should be dry, and there should be a plentiful supply of
water, and means of proper drainage. The want of
water, in places where large numbers are collected, of
whom many are invalids, and many extremely dirty, is
obviously a serious calamity. The buildings should
be surrounded with land sufficient to afibrd out-door
employment for the male, and exercise for all the
patients, and to protect them from being over-looked, or
disturbed by strangers. In the best asylums (such as

* It is singular that in one of these houses two, and in the other
one person, have lost their lives by fire in their separate rooms. There
was a fire at the York Asylum, in the year 1813, in which four per-
sons lost their lives. There has also heen a slight fire at the Gloxices-
ter Asylum, in the main building, and in a gas house at Hanvvell, but
no accident happened, and little excitement took place anaong the
patients on the happening of either of these events.

After the Surrey Asylum was made fire-proof in the part occupied
by the patients, the chapel was required to be made fire-proof, and
this was effected at a very considerable additional cost.

those for the counties of Surrey, Kent, and the West
Riding of Yorkshire) these and other important mat-
ters* have been attended to ; but in others they have been
partially or wholly neglected.

St. Peter's Hospital, Bristol, is situate in the centre of St, Peter's
the most crowded part of the city, and has for the pur- 3^510/ '
poses of exercise, only half of a small paved court for
the males, and for the females an equally small court,
used, also, as a road, and which is, in every respect,
quite unfit for the purpose to which it is appropri-
ated. The Asylum for the county of Pembroke, at Asylum at Ha-
Haverfordwest, was once a town Gaol, and, in its '

present state, is an ill-constructed Prison. For its total
unfitness for the care of pauper lunatics, we must refer to
the description of it, in a subsequent part of this Report.
The site of the Asylum at Nottingham is partly sur- Nottingham ;
rounded, and commanded by adjoining buildings. It
contains 177 patients, but has not more than three
acres of land, besides what is occupied by the build-
ings, garden and yards, and we understand that there
is no opportunity of purchasing any more adjoining
ground. The present medical superintendent himself
took a farm, for some time, with the view of finding
employment for the male paupers, but his other duties
prevented his continuing to occupy it. Inconvenience
has been experienced at the Asylum for Dorset, and Dorset ;
at Lancaster, from the yards and wards being too Lancaster;
close to the boundary wall. At Hanwell, the ward Hanwell ;
for the worst class of females, and the large exer-
cising ground for the women, are both liable to the
same annoyance, being only separated from the land
of other proprietors by a wooden paling. At Leicester, Leicester ;

* The Galleries and Day Rooms at the Leicester and Dorset
County Asylums, are very good. The Yards of Gloucester, and the
Grounds at Hanwell, are spacious and very well adapted for exercise.
Many of the arrangements at Stafford have been much approved ; and
amongst other important advantages, the Kent and Lancaster Asylums
have detached Infirmaries for each sex.

Norfolk ;

Lancaster :

Bedford.

Want of water
at Bodmin ;

Lancaster and
Han well.

Importance of
warmth, venti-
lation, Si.G.

containing 131 patients, there are only four or five
acres of land, besides the site of the buildings.
The Norfolk Asylum, with 220 patients, has only
five acres of land, of which not more than one acre
and a half, used as a kitchen garden, can be applied to
the employment of the patients. At Lancaster, where
there are 611 patients, they had originally only five
acres, subsequently increased to fifteen; and last year
the magistrates of the county were obliged to apply
to Parliament for, and obtained an Act to enable them
to purchase the additional land, which was essential
for the proper care of their patients. At the Asylum
at Bedford, with 139 patients, there are only six
acres, besides what is covered by the buildings and
yards, part of which is used as a burial ground. The great
value of out-door occupation as a means of restoring the
insane poor, (even those whose employments have been
previously sedentary,) to health of mind, and of promot-
ing tranquillity, renders the want of a sufficient quantity
of land a very serious defect in the above-mentioned
Asylums ; and thisj in some instances, cannot be
remedied without removing the Asylum altogether.

The Asylum of Bodmin is frequently short of water,
and had been so during a whole week at the time of
our visit to it in 1843, when the discomfort and evils
resulting from this deficiency were very perceptible.
There has also been considerable difficulty about the
supply of water at the Lancaster Asylum. At Han-
well, one well has failed, and this large establishment
was mainly dependent on the Grand Junction Canal
for its supply, which was obtained at a cost, during
several years, of 1401. a year ; but the Company having
refused to continue the supply, the Visiting Justices
have been compelled to sink an Artesian well, whifli
has cost 1,483^.

The importance of warmth, ventilation, and dryness,
in Limatic Asylums, will be understood by the fact

that at Stafford, as was stated to us, in 1842, that " an
improved system of warming and ventilation had been
recently introduced with success, since which no cases
of dysentery, formerly prevalent, had occurred ;" and
at the Dorsetshire Asylum, in 1843, we were informed,
that, " from the floors having been damp, the patients
were formerly subject to dysentery, but they had been
taken up and relaid, and not one of the patients
admitted since the alteration had suffered from dysen-
tery." Many Lunatics are not only sickly, but are so
filthy in their habits, that they nearly frustrate all
attempts to keep them clean, and can only be allowed
to sleep upon straw or other bedding which may
be thrown away, or washed every day. In cases of
this sort, a free circulation of air is very important.
The ventilation at the Asylums for the counties of
Kent, Surrey, and some others, is very good; whilst at
Hanwell, and at Bodmin, it is in some parts extremely
defective.

It is indispensable to the comfort and health of the
inmates of Lunatic Asylums, that proper provision should
be made for warming and ventilating the Galleries and
Dormitories, so that the Patients may breathe a pure
atmosphere, of a moderate and even temperature. It is
also essential to their enjoyment, that the interior of the
building should be light and cheerful. A large propor-
tion of the Patients, more particularly the Females, spend
a great part of the day in the Wards ; and it is verv
desirable that the Galleries should be so constructed and
lighted as to form convenient places of exercise and recre-
ation in rainy weather, and in the winter season. It is
especially important that these considerations should be
kept in view, in the erection of Asylums. If they are
neglected in the first instance, much additional expense
must be incurred in remedying the original defects :
whilst the evils arising from tainted air, and an unequal
c

Arrangements
for warming
and ventilation
in Asj'lums
visited.

Steam Appa-
ratus, &c.

Advantage of
open fires.

Mode of warm-
ing Chester
Asylum ;

Nottingham
Asylum ;

Leicester Asy-
lum :

temperature, can, in many cases, be only partially abated
by subsequent alterations.

We have endeavoured to ascertain, as regards Wanning
and Ventilation, what arrangements are made in the
several Asylums which we have visited, and what plans
have been found, most successful.

The mode of warming frequently adopted is by means
of a circulating steam or hot-water apparatus, which, in
the older Asylums, has, in most instances, been substi-
tuted for the open fires, or stoves, formerly in use.

In adopting this arrangement, consideration has been
had to economy of fuel, to the saving of trouble to the
Attendants, and to lessening the risk of danger to the
inmates ; but open fires have the advantage of cheer-
fulness, and chimneys materially promote ventilation
at those seasons of the year when artificial heat is not
required. In the Chester Asylum, on the occasion of
our first visit, in August, 1842, we found open fires still
in use on the Female side, principally, as we were in-
formed, with a view to the enjoyment of the Inmates,
who much preferred them to a heating apparatus, as
being more cheerful. The Male Division was warmed
by means of hot-water pipes, passing through the upper
Galleries ; the furnace to the boiler answering the purpose
of a Stove for the Basement Story, in which the Patients
of uncleanly habits were placed.

At the Nottingham Asylum, steam pipes have been
substituted for a hot-air apparatus, the latter having
been found ineffectual for its purpose. The steam is
generated by the boiler of an Engine, by means of which
water is pumped up into a Reservoir above the level of
the upper Galleries. Over this Boiler is an excellent
Drying Room.

The interior of the Leicester Asylum is '' warmed
by atmospheric air conducted in brick drains, and passed
over iron plates and pipes made hot with boiling water ;

and the air, when heated, is conveyed by brick tubes to
the several Dormitories and Galleries, and the vitiated
air is allowed to escape through Conductors into the
roof, from whence it is discharged by turn-caps, or
cowls, regulated by vanes."

At the Kent Asylum, the warming and ventilating Kent Asylum
arrangements were designed and carried into execution
at the time the Buildings were erected, and consist (as
described by the Architect) of " a large volume of pure
atmospheric air, passing from the yard, through channels
under ground, into a Chamber where it is warmed in
winter, by passing over a large surface of hot- water pipes,
and from thence enters the Galleries in a large volume
near the ceiling, and into the Sleeping Rooms. — It is
from thence drawn off through apertures near the floor,
and into air drains which communicate with fires in
the Cellar, thus ensuring a constant change'of the air,
as the fires are supplied entirely by the vitiated air from
the Galleries and Sleeping Rooms." The apparatus has
been in use several years, and has been found to answer
perfectly. The Superintendentj to whom we are indebted
for the foregoing particulars, adds that hot water is the
medium used for warming the air in the new Building ;
but that in the old Building, the air is warmed by a
cockle and tubes, the principle in other respects being
the same. Hot- water tubes or pipes are consiered by him
preferable to the latter, " as the air cannot be heated
above the temperature of boiling water, and conse-
quently is never burnt."

In reply to our inquiries at the Gloucester Asylum, Glouceeter
we have received from the Superintendent the following *^ "™ '
statement : — " In the Refractory Wards, the Sleeping
Rooms are both warmed and ventilated by air passing
through chambers, inclosing pipes of warm water. The
same principle is here adopted as at the Pentonville
Prison ; and was one of Mr. Haden's first attempts to
effect the circulation of warm air from above down-
c2

wards. It is very good, and answers extremely well." —
Upon two several occasions, however, when this Asy-
lum was visited by the Commissioners, the ventilation
of the Basement Story, especially in the cells appropri-
ated to the dirty class of Patients, appeared to be
extremely indiflferent.

Surrey Asylum; In respect to the Surrey Asylum, (the last County
Asylum which has been erected,) the House and Galleries
generally are warmed by the circulation of Steam, and
the introduction of Hot Air through apertures in the
floor. The temperature is regulated by stop-cocks,
and kept between 56° and 58°. There are open fires,
with proper guards, in the several Day Rooms on the.
Female side ; and it is proposed to adopt them also in
the Male division. We drew the attention of the Super-
intendent to the defective ventilation of some of the
Pauper Dormitories on the third floor, which we were,
informed by him had also been noticed by the Visiting
Justices.

We have elsewhere adverted to the want of proper
ventilation in some of the Wards or Sleeping Rooms

Ha iwell Asy- in the Hanwell Asylum, more especially in the Base-
' ment Story on the Female side. And we have, when
visiting other Asylums, pointed out similar defects to
the Superintendents and Medical Officers.

St. Luke's Hos- The Galleries in St. Luke's Hospital, which are spa-
* cious and airy, are not artificially warmed; and com-

plaints were made to us of their being cold in winter. The
only fires in the Wards are those in the Day Rooms and
Nurses' Apartments. We were informed, however, that
plans were under consideration for the introduction of a
hot- water apparatus, with grated openings in the lower
part of the doors of the Sleeping Rooms. The ventila-
tion of these rooms, when we visited the Hospital, ap-
peared to be imperfect.

Lincoln A.sy- At the Lincoln Asylum ; the Day Rooms, of which

there are eight in each division of the Asylum, are

warmed by open fires. The Galleries, which appeared to us
as likely to be very cold in winter, are not artificially
warmed, the stoves and flues formerly in use having been
discontinued in the year 1836. Upon this subject, the
Board of visitors, in January, 1843, amongst other
Regulations for the Medical Treatment of the Patients,
passed the following Resolution : " That no system of
warming this house, by means of which the Patients
may breathe a heated atmosphere, be introduced."

We proceed to offer a few observations upon the size Observations on

J i p ^^ T\ -i • J • 1 oi • dormitories snd

and arrangement of the Dormitories and single Sleeping ^-^^ ^^jj^

Cells. In respect to the latter, it appears desirable,
on every account, that they should be on only one
side of the Gallery, and that they should not be ranged
back to back, as is the case at Lancaster and Glou-
cester. Galleries, with Sleeping Rooms on both sides,
are generally gloomy, and the ventilation is necessarily
imperfect. Where the original construction of the
Asylum, or the number of Patients to be accommodated,
renders such an arrangement unavoidable, it is desirable
that recesses extending to, and lighted by windows in the
outer wall could be left at intervals between the sleeping
rooms, so as to form part of the galleries, the ventilation
and general cheerfulness of which will be thereby mate-
rially promoted. Light should also, in all cases where
it is practicable, be admitted at the extremities of the
Galleries. The Galleries in the Surrey Asylum, in Galleriea in
which thei'e are Sleeping Rooms on both sides, are wide
and airy ; those on the upper floor being well lighted
by cupolas. This plan, in some degree, diminishes the
force of the objections that we have stated.

Upon the subject of single Rooms as connected with ven- Dormitories
tilation, we would observe that, unless they are perfectly P.'^^f ^^^^ '"

' ^ J r J single rooms.

ventilated. Dormitories, with a limited number of beds,
are preferable. Such Dormitories present the advantage of
a more free circulation of air, and more even temperature.
Single Rooms, where adopted, should be of good size.

Those in the new Wings at the Bedford Asylumj
which are constructed only on one side of the Galleries,
are of inadequate dimensions, being only six feet six
inches in length, by six feet in width, and about eight
feet high. We found them, however, clean and free
from any offensive odour. The usual size of the single
Cells in County and Public Asylums is from nine to ten
feet in length, and seven feet in width; and the ave-
rage solid measure of each is about 700 cubic feet.
Use of base- The USB of basement stories below the level of the

ment stories Tot t . . jiiii -jj i

Patients to be adjoining ground should be avoided as much as pos-
avoidcd. giijie foj. occupation by Patients. They are used in

the Suffolk Asylum and at Nottingham and Hanwell.
Some of the cells on the basement floor at Nottingham
can scarcely be considered as fit for invalids ; and many
of the sleeping-rooms on the basement story at Han-
well, are dark, cold, and ill ventilated. Much has been
done at the Surrey Asylum to render the basement
story cheerful and airy, by making the windows open
upon green grass slopes, instead of into areas ; and the
same plan has, also, been partially adopted at Hanwell.
An Asylum An Asylum should have cheerful and spacious day

cheerful and rooms, easily accessible from the yards. An opinion was
spacious day expressed by the Resident Physician of Hanwell, before

roouaS. , fiTT p T ^ ^ • 1 '

a Committee of the House of Lords, that it was desir-

Use of galleries able to have the day rooms formed in the galleries: but

as day rooms ; ^|^g ^j^her Medical Officers and Engineer of that Asylum

did not, on our mentioning the subject, concur in this

at Hanwell ; opinion. One of the galleries for females, in Hanwell, is

in the form of three arms of a cross, and has one arm

Bodmin ; entirely occupied by a table and benches. At Bodmin,

the day rooms generally form parts of the galleries, and

partitions have been erected to keep the patients away

from their bed rooms in the day time, and to prevent

the smell and inconveniences resulting from their

using the galleries as dining rooms.

Kfent Asylum. la the Kent Asylum, the galleries constitute the

only day rooms for the patients, an arrangement which
we think of very doubtful advantage in this otherwise
excellent establishment. Galleries are intended as places
for exercise for invalids, and for all the patients in bad
weather, and the necessity of placing chairs and tables
in them, and the preparations and removals before and
after meals, greatly interfere with this object.

The yards of Asylums should be constructed so as to Constructiou of
have as much light, sun, and prospect as possible. With ^^^ ^'
this view, there were raised, in the yards of the Asylum
at Wakefield, (erected in 1815,) mounds affording a view
of the country over the walls. Similar but more per-
fect arrangements have been made since at the Surrey,
Lancaster, and other Asylums. The yards, however, at
Bodmin, Nottingham, and Leicester, are for the most
part dull and gloomy, from being surrounded by high
walls. Many of the yards at Hanwell are enclosed by
walls and buildings, and some are placed between the
main building, the farm-yard and piggeries. The
yards in the Asylum for the county of Norfolk,
are extremely defective ; and those in the Asylums for
the counties of Dorset and Kent, are not cheerful or well
laid out. Every yard ought to contain a shed for shelter
from the sun.

Another point connected with the construction of Limitation of
county Lunatic Asylums, and which requires much T^ f County
attention, is the size to which each should be limited.
Out of fifteen coxmty Lunatic Asylums already erected,
ten have accommodation for not more than 200
patients, whilst the remaining five have room for larger
numbers. The Asylum for Kent will contain 300 ; for
Surrey, 360 ; for the West Riding of York, 420 ; for
Lancaster, 600 patients ; and the Asylum for Middlesex
has beds for 1,000 patients. From the best opinions
that we have been able to collect, and from the result of
our own observations and experience, we think it is
desirable that no asylum for curable lunatics should should not con-

, 1 nr • 11 • *^'° more than

contam more than 250 patients, and that 200 is perhaps 250 patients.

Magnitude of
Hanwell incon-
venient.

Consequences
of disuse of
restraint.

as large a number as can be managed witb the most be-
nefit, to themselves and the public, in one establishment.*

It has been generally considered to be an advantage
in England, that our public hospitals are less in size
than they are in France and on other parts of the Con-
tinent, and that the patients are on this account better
attended to in our hospitals. "We have, in other parts of
our Report, alluded to some evils and inconveniences
which have been experienced at Hanwell, owing to its
extreme magnitude. The two resident Medical Officers
have, between them, nearly 1,000 patients to attend,
and are required by the rules to see every patient
twice a day. Each of these Officers has an average
of 30 persons on the sick list, and about 50 on the
extra-diet list. Besides these duties, they have to mix
the medicines, and to keep the registers and diaries.
Some attention is also required to be paid to chronic
cases, in which the general health and state of mind are
often varying. This Asylum contains 100 officers
and servants, residing in the buildings besides employing
between 50 and 60 out- door labourers and mechanics.

The diminution and disuse of restraint in Asylums
have been accompanied by an increase in the number
of attendants, and by confiding to them a greater
power of control over the patients. The delegation of
so much authority, as, in large asylums, is now neces-
sarily placed in the hands of attendants, demands a
proportionate increase of vigilance in the Superintend-
ents. At Hanwell, much importance is attached to
having a superior class of attendants, to be employed
in carrying into effect the system of management which
exists there ; but we found that a large proportion of the
female attendants had been in the Asylum only a short
period, and had not previously been employed in any

* The Legislature has recognised the expediency of limiting the size
of Asylums by enacting (1 and 2, Geo. IV., c. 33), that the District
Asylums in Ireland, " shall be sufficient to contain not more than
150" Patients.

similar establishment. There is, however, sometimes DifBculty in
great difficulty in finding good attendants for Asylums, attendants •
and where more than eighty are employed, it is pro-
bable that there must necessarily be frequent changes.
We think that the assembling, under one roof, of so
many patients and servants, as are now in Hanwell
Asylum, is calculated to render it difficult to main-
tain that order, regularity, and subordination, which are and of main-

„ taining oider.

essential to the good management of a receptacle for
the insane. These considerations are especially import-
ant at a time when, as we are informed, there exists an
intention to increase the Asylums (already so large) for
the Counties of Middlesex and Lancaster. "We trust
that the Magistrates of those districts will deliberate
seriously before they resolve upon a measure of such
doubtful expediency.

By the Act 9 Geo. IV. c. 40, sect. 8., it is enacted Election of

Committee of

that, in the case of every County Asylum "it shall be visiting justices
"lawful for the maior part of the Justices of the Peace, "' °"°'y •

J i ' Asylums, under

" at the Michaelmas General Quarter Sessions in each 9 Geo. IV. c.

40 s. 58.
" year, to elect a Committee of Visiting Justices, for the

"Management of such County Lunatic Asylum, and to

" fill up any vacancy in the number of such Committee as

" may have occurred by death, or resignation ;'' and by

the 30th sect, of the same Act, the Visitors are required

" from time to time, to make regulations for the man-

" agement and conduct of the Asylum ; in which regu-

*'lations shall be set forth the number and description

" of Officers and Servants to be kept, arid their respec-

" tive duties and salaries ;" such Officers and Servants

to be appointed and dismissed by the Visitors. The Regulations fre-

first of these provisions appears to be in general complied i^^^^ ^ °^^"

with, but the regulations are frequently neglected to be

made.

In the Asylum for the County of Bedford, however,

there seems to be no Committee elected ; the whole body

of Magistrates being appointed Visitors, and almost the

entire control of the County Asylum being delegated to

Appointment
and dismissal of
servants.

Rules for ma-
nagement of
County Asy-
lums left by
law entirely to
Magistrates.

General rules
desirable.

Publication of
annual accounts
important.

Rules for relief
of certain pau-
per lunatics
when discharged
important.

the Medical and General Superintendent, who appoints
and dismisses servants, and occasionally discharges
patients of his own authority. There is also no set of
rules, for the direction of the officers and servants of this
Asylum. We consider that the appointment and dis-
missal of servants is a trust of great importance, which
is vested in the Visiting Justices for the purpose of
checking any undue power or influence being used by
the superintendent over the servants of an Asylum.

In the County of Chester, at our first visit, no Com-
mittee of Visiting Justices had been elected, but all the
Magistrates acted as Visiting Justices. They seldom
visited the Asylum, the superintendence and manage-
ment of vphich was confided, until lately, almost ex-
clusively, to the Visiting Physician, upon whom a very
serious responsibility was thus thrown. In some other
Asylums, the hiring and dismissal of servants appear to
be entrusted to the Medical Superintendent and Matron.

The law has left the formation of rules for the manage-
ment of County Lunatic Asylums entirely to the Magis-
trates. Whilst these institutions were comparatively new»
this might be unobjectionable ; but now that they have
become numerous and of great importance, and are
maintained at a large public cost, we think that some
general rules should be laid down for their management,
and some uniform but concise tables framed for their use,
in order to their making periodically certain statistical
returns. It is important that an account should be
published of the annual expenditure of every County
Asylum, (as is already done in many cases,) as well
as of the original cost, and all the current expenditure,
in proper detail. Some opinion might then be formed
as to the comparative good management and efficiency
of each of these Asylums. We think it of importance
that some rules should be laid down for the relief of
certain Pauper Lunatics when discharged. Pauper
Lunatics who are sent from a Parish, or a Workhouse,
have> on being discharged, either their own home

or the Workhouse to return to, until they can find
employment and the means of subsistence. Paupers,
however, whose Parishes are unknown and who are sent
as County, or Vagrant Paupers, and are maintained at
the charg-e of Counties, have, frequently, on being dis-
charged, no home or Workhouse to which they can
resort until they can obtain work. Our attention has
been called to this subject, on more than one occasion.

At the Bethnal Green Asylum, whenever any County Practice at
Pauper has been discharged as cured, it has been the ^^'^"^^ ^""^f.^

■r o ' Asylum on dis-

custom, if the Patient has conducted himself well, to charge of Pau-

, . . . , , , per Lunatics.

gjve him permission to return to sleep and have some
meals, until he can find employment. This has been
charitably allowed from a conviction that such persons,
if suddenly turned adrift without a home, or the means
of procuring food, would, in most cases, be soon sent
back under a relapse brought on by destitution. When
it is stated that in 1842 there were, in the County Asy-
lum of Lancaster, 118, and in 1843, in the County
Asylum for Middlesex, 126 County Paupers, or
Vagrants, who, upon their discharge would have no
Workhouse, and probably no home to repair to — it
will probably be thought worth while to make some Some provision
provision for Patients of that class in the event of their uent^necessary.
liberation.

The destitute condition of many Pauper Lunatics on Charitable
leaving Asylums, has induced benevolent individuals to of discharged
raise funds for their assistance. A gentleman of the P*"P^i' Luna-
name of Harrison left a sum of 1000^. to the Asylum
at Wakefield for this purpose. The Adelaide fund
having the same object, was set on foot by the chari-
table exertions of the Visiting Magistrates at Hanwell,
and in 1842, amounted to 5000/. At the Gloucester
Asylum, where there is a similar fund, amounting to
about 800/,, small sums of money and occasionally
also tools, are lent to Patients on their liberation.
There is a similar fund, instituted by Lady Middleton,
at Nottingham ; and upon the same principle, assistance

Rule adopted
by Middlesex
Magistiutes as
to Pauper
Lunatics' settle-
ments.

Recommenda-
tion as to ap-
pointment of
resident Medi-
cal Officer in
Public Asy-
lums;

and Visiting
Physician in
County Asy-
lums.

IS given to poor Patients on their discharge at St. Luke's.
It may deserve consideration whether, some arrange-
ment should not be adopted generally with a view to
provide assistance for poor Patients on their discharge.
Relapses are frequently attributed to the want of some
such relief.

At the suggestion of the Visiting Justices of Hanwell,
the Magistrates of the County of Middlesex have agreed
not to adjudicate Paupers as County Patients, without
previous notice to the County Solicitors, and a minute
investigation of each case. The result of this judicious
arrangement has been, that the Settlements of many
Paupers, previously charged upon the County, have been
discovered, and a considerable saving to the County has
been thus effected.

By the Act 2 & 3 Will. IV. c. 107, every licensed
Asylum containing 100 patients (or more), is required to
have a resident Medical Officer, and it is important that
a similar regulation should be made in reference to
Public Asylums. It is to be observed that all the County
Asylums possess resident Medical Officers, except those
of the counties of Bedford, Norfolk, and Pembroke,
(Haverfordwest). We think it, also, in many cases,
desirable that County Asylums should have a Visiting
Phvsician, in addition to the resident Medical Officer.

In the case of the Asylum at Hanwell, the Visiting
Justices have lately appointed a gentleman (formerly an
Officer in the Army), who has had no previous expe-
rience in the management of the Insane, as the Governor.
The appointment appears to have become necessary in
order to preserve good order in this large Establishment ;
and for that purpose, the Governor has the power of sus-
pending, not only the servants, but even the Medical
Officers and Matron of the Asylum. He has also the
entire control over the classification, employment, amuse-
ments, instruction, and general management of the
patients both male and female, subject only to the
general control of the Visiting Justices.

It is apparent, from the foregoing remarks, that General re-
althoUgh a few of the existing County Asylums are ^v Asylums.
well adapted to their purpose, and a very large pro-
portion of them are extremely well conducted; yet
some are quite unfit for the reception of the insane,
some are placed in ineligible sites, some are defi-
cient in the necessary means of providing out-door
employment for their paupers, some are iU-contrived
and defective in their internal construction and accom-
modations, some are cheerless and confined in their yards
and airing- grounds, and some are larger than seems '
consistent with the good management of their establish-
ments and the proper care and health of their patients.
"When in addition to these defects in the Institutions
themselves, the very large cost at which they have been
erected is taken into account, it appears to be deserving
the consideration of the legislature, whether the erection
of Public Asylums for the insane poor of the country
may not be advantageously regulated by some inde-
pendent authority. Although county magistrates have
properly the control of the expenditure of funds to be
raised in their own districts, it can scarcely be expected
that they should devote so much attention as is really
necessary to make them conversant with the various
points which involve the convenience, comfort, and
security necessary to be provided for in large Asylums
for the insane, and they are therefore liable to be misled
as to their proper cost and construction.*

• Surveyors and architects should be especially directed to visit the
best constructed Lunatic Asylums, previously to the preparation of
plans for new Establishments. The plan of the Asylum for the
County of Devon, not yet opened, has been much objected to : it
is somewhat similar to that of the Lunatic Asylum for the County
of Cornvcall, which has been found ill suited to the purposes for
which it was erected. Whilst visiting the Asylum at Hanwell,
we met several parties examining the buildings, with a view of
preparing plans for a Pauper Lunatic Asylum for the County of
Derby ; and from perusing the printed minutes of a Committee of - ' ^

Magistrates of that County, we fear that they have been led to adopt
some of the defects of the Hanwell Asylum.

Pauper Lunatics have unfortunately become so
numerous, throughout the whole kingdom, that the
proper construction and cost of Asylums for their use,
has ceased to be a subject which affects a few counties
only, and has become a matter of national interest and
importance.

Asylums erected
under 48 Geo.
III. c. 96, and
9 Geo. IV. c. 40.

Weekly pay-
ments for pau-
pers in certain
County Asy-
lums.

2. — County Asylums, partly supported by
Contributions.

In respect to the Asylums for the counties of Corn-
wall, Gloucester, Leicester, Nottingham, and Stafford,
which have been established at the joint expense of
counties and subscribers, it is to be observed that they
were erected under the provisions of the Acts 48 Geo.
III. c. 96, and 9 Geo. IV. c. 40. From the recitals
in the former of those Acts, the intention of the Legis-
lature appears to have been to encourage Asylums of
this description ; first, on the ground of the payments
of the richer being applied towards the maintenance of
the poorer classes of Patients; and secondly, on account
of the advantages which they were likely to afford to
Pauper Lunatics.

We have not been able to ascertain, with accuracy,
what has been the extent of the relief contributed in
these Asylums to the poorer private Patients, from the
excess of the payments of the richer private Patients, and
we are therefore unable to say, how far the charitable
objects of the Legislature have been realised in this
respect. But, as regards the advantages which have
been conferred by these Institutions upon Pauper Luna-
tics, it appears to us that they scarcely equal those of
County Asylums erected exclusively for Paupers ; whilst
the maintenance of Paupers in them is fully as expen-
sive as in Asylums established solely for paupers.

In the Asylum for the county of Cornwall, the pay-
ments of the higher classes of private patients are
applied in diminution of the expenses of the paupers.

for whom the weekly payment is 5^. 6d, The weekly
payment for paupers at Leicester, is 8*. 6d.; and at
Staflfbrd, 7*., in each case, exclusive of clothing ; and at
Gloucester, 9*. and at Nottingham, 8*., including
clothes. In some of these Asylums, the better part of
the buildings and airing grounds are given up to the
private patients, to the exclusion, in a great measure, of
the paupers.

It is right, however, to observe, that the defects of Contributors
some of these Institutions maybe attributed to their c° /" sen ers

•' tii'st promoters

having been amongst the first Public Asylums that were "f » ™il<i
erected, and that the contributors and subscribers to
them were amongst the first promoters of a mild and
humane system of treatment for the insane of all
classes. "Whether Institutions may be formed, in which No opinion
private patients shall have all the comforts which their ^^^^^^ ^^ *"

* '^ formation of

circumstances afford, and the poor may also be properly improved mixed
taken care of at a diminished expense to the country,
is a question upon which we do not at present offer an
opinion.

3. Military and Naval Hospitals.

The Military Hospital at Fort Clarence, near Chat- Military Hos-
hara, is well situated. That part of the fort which is appro- ciarence de-
priated to the residences of the Officers is very gloomy, scribed.
and ill suited for a receptacle for Insane persons. Some
of the sleeping-rooms for the private soldiers are suffi-
ciently good, but others are dull and cheerless. The
exercising-ground for the Officers, and the yards for the
soldiers, are cheerful, but are not sufficient in number
or size. The buildings and grounds admit of great
improvement ; but we understand that the inmates of this New Asylum
Hospital are about to be removed to a new Asylum. opened."

That part of the Naval Hospital at Haslar which is Naval Hospital
set apart for Officers of the Navy and seamen afflicted
with Insanity, is admirably adapted to its purpose. The

rooms are lofty, spacious, and airy ; and they command a
view of the entrance to Portsmouth harbour. There are
excellent exercising-grounds between the Hospital and
the shore, and the Patients are frequently taken out in
boats.

General re-
marks on Public
Hospitals.

Guy's Hospital,
and Bethel at
Norwich.

Comparative
receipts from
private patients.

Advantages en-
joyed by them.

Payments at
Lincoln and
Northampton
for paupers.

4. Public Hospitals, supported wholly or
PARTLY BY Voluntary Contributions.

Having obtained authority from your Lordship to visit
the different Lunatic Hospitals in the kingdom coming
under this class, it will be expected that we shall make
some remarks upon their condition. These Hospitals
differ materially from other Hospitals for the Sick in this
respect, that although most of them derive some portion
of their income from a charitable foundation, the patients
admitted into them invariably pay the greater part, and
sometimes the whole, of the expense of their own main-
tenance and medical attendance. The Lunatic Ward
of Guy's Hospital, and, to a certain extent, the Bethel
Hospital at Norwich, are exceptions to this rule. The
sum received from private patients, and for board and
lodging, in the year 1842, at the Retreat, York, was
4l39;.2.s. lie?.; at St. Luke's, 1526Z. 8*. ; at Lincoln,
(1843), 3559^. 19s. Ud.; at Exeter, 1735^.; at the
Warneford, near Oxford, 1098L 10*. 6d. : and at North-
ampton, 514U. 18*. 5d. Private patients who have been
in better circumstances, derive much benefit from the
comforts and advantages which these Institutions supply,
at a moderate rate of payment.

There were eighty- three pauper patients, in 1843, at
the Lincoln Asylum, for whom the payment made by
their parishes was 10*. per week for each person, and at
Northampton there were 192 paupers, for whom the
payment was 9*. per week for each person, not in-
cluding clothes in either case. These sums are higher
than are usually charged for paupers in licensed houses.

The founders, however, of these Institutions did not
intend them for the benefit of rate-payers.

The internal accommodations and grounds of the Comparative

, . , , accoinmoda-

Retreat, near York, are admirably adapted to promote tions.
the benevolent objects for which that Asylum was
established. The Lincoln Asylum is extremely well
situated, and the buildings are commodious and well
suited to their purpose, but at the time of our visit,
there was no land for employment. Some of the rooms
at Exeter are cheerful, and command good views, but the
yards are surrounded by unusually high walls. The
Warneford Asylum, near Oxford, is well situated, and
the grounds are well laid out. Saint Luke's Hospital is
ill placed, and is extremely deficient in airing-grounds.
The galleries, however, are very spacious. From the
curative wards of this Hospital, cases of epilepsy, para-
lysis, and idiocy, and also cases of more than a year's
standing are excluded ; but there is a ward appropriated
to incurables, limited to 100 patients. The Asylum at
Northampton is well situated : the buildings are well
arranged ; it has several walled yards, and also extensive
grounds, in which the patients who can be trusted, take
exercise, and which, from the circumstance of their being
bounded by banks and hedges, instead of high walls (as
is usual in other Asylums) possess a character of great
cheerfulness. The Bethel Hospital at Norwich, and
the Asylum at Manchester, from their sites and accom-
modations, are very ill adapted for receptacles for the
Insane.

In some of these Public Hospitals, the Governing Exemption
Bodies claim, on behalf of their Institutions, an entire ^l"™ ''f}^^^^^

' claimed in som<

exemption from Visitation. We cannot, however, but cases.
think, that all places receiving and detaining in custody
any class of Her Majesty's subjects, should be open to
inspection by proper authority ; and we do not perceive
anything in the constitution of Hospitals of this nature
that distinguishes them from other Public Asylums, or

provides any sufficient security against the chances of
abuse.

3. Licensed Houses.
Licensed The Houses which are licensed for the reception of

Houses consist x •i^ii?^!. i_-T-j-ii

of three classes. I"sane persons consist, nrst, ot those which admit only
Private Patients; secondly, of those which admit both
Private and Pauper Patients ; and lastly, of the licensed
parts of Workhouses, which receive Paupers only.

Our object, in this Report, is to bring before your
Lordship's especial notice, such instances of existing
evils in Lunatic Establishments in general as are of mag-
nitude, and require immediate correction ; leaving such as
are of less importance, and appear to be in a state of
progressive amendment, to the effect which a strict inves-
tigation cannot fail, in the course of time, to produce.
With this view, we think it expedient, on the present
occasion, to advert more especially to the character of the
Licensed Houses which receive Paupers, and which are
necessarily resorted to on account of the Public Asylums
being wholly insufficient for that class of Patients. It is
in these Houses that the principal defects have been found.
In regard to Licensed Houses which receive Private
Patients only, although many of them are susceptible of
improvement, their prosperity is more essentially dependent
on their good conduct, and they therefore present less
occasion for animadversion.

Some of the Establishments, which receive Private
Patients only, possess every accommodation and conveni-
ence which comfort, or even luxu)*y, can require ; and in
them the Patients are generally treated kindly and
judiciously. We abstain from pointing out specially the
Houses of this class which we consider to be the best, in
order that we may not indirectly affect the character of
others, which, although inferior in accommodation and
arrangement, are nevertheless well conducted. These
remarks, it should be observed, apply not only to Houses,

receiving Private Patients only, which are situated in the
Metropolitan district, but to some in the Provinces.
The former have for many years been under our exclu-
sive jurisdiction, ahd their condition has been frequently
the subject of former Reports to your Lordship ; and
although very great improvements have been made in
many of them, and no important defects in their manage-'
ment demand particular notice from us at present, we are
nevertheless convinced that some of these very houses, of
which we now speak in terms of commendation, would
soon become the scenes of great abuses, were it not for
the checks interposed by the constant and watchful visit-
ation to which they are subjected.

It is due to the Proprietors of Licensed Houses in the Alterations and
provincial districts, to state that alterations to a consider- •"pro^ciuents.
able extent have been already made by several of them,
upon our suggestions ; that others are in progress ; and
that, upon the whole, a decided improvement has already
taken place in some parts of these Establishments, though
much still remains to be done. There are some of these
Houses, however, which require to be greatly altered
before they can be considered as fit receptacles for the
Insane ; but the Proprietors having expressed a willing-
ness to make improvements, we shall not call particular
attention to them on the present occasion. Should our
expectations of amendment not be realised, we shall think
it our duty to bring before your Lordship's notice such
defects as may continue to exist, in our next Report. It
will be necessary, however, even in our present Report,
to advert to certain irregularities and partial defects in
some of these Houses, which ought not to be passed over.

At the Licensed House of the Rev. Dr. Chevallier, at irregularities at
A spall Hall, in the county of Suffolk, who is a practising Asi,an*'Hali"'''
Physician, as well as an officiating Clergyman and acting Suffulk j
Magistrate of the county, there were at our first visit, in
1842, three certified Patients, and eight other ladies and
gentlemen, who were reported to us as not Insane, residing
D 2

there as boarders. One of these gentlemen was stated to be
the Curate of a neighbouring church, and he was therefore
not examined: it was, however, afterwards ascertained
that he had been previously confined as Insane. The
other boarders were examined. One of them was a
Clergyman who had been previously confined under cer-
tificates, and was still low-spirited ; another was an im-
becile young man, not fit to be trusted in society ; a
third was a lady who was manifestly Insane ; a fourth
was a gentleman who fancied that he was becoming In-
sane ; and a fifth was his companion. The remaining
two boarders were ladies of weak minds and nervous
habits.

The Visiting Justices subsequently examined five of
these boarders, and came to the conclusion that three of
them were of sound mind, that one was Insane, and that
the mental condition of the fifth was doubtful. At our
second visit, we were satisfied that one of the male
boarders, whose case was considered as doubtful by the
Justices, was decidedly of unsound mind; and he aftei'-
wards became so manifestly Insane, that he was removed
in a hopeless state to another licensed house, as a cer-
tified Lunatic. This gentleman had been permitted to
execute some deed or instrument during his residence in
Dr. Chevallier's House, with his privity and approbation,
by which some cottages were said to have been leased or
disposed of.
At Dr. Allen's, At our first visit to the House of Dr. Allen, at High
Essex •^^'^ ' Beach, in the county of Essex, in September, 1842, we
found a gentleman, residing as a boarder without certifi-
cates, whom we had known as a certified Patient in one of
the Houses in the Metropolitan district : this person was
evidently unfit to be at large. Dr. Allen stated that he
had been in the habit of sometimes receiving low-spirited
or desponding persons as boarders. He also said that he
had, on several occasions, permitted patients in his Esta-
blishment to execute deeds afifecting property, but that

before doing so he always satisfied himself that the act
was proper. There are three different houses belonging
to Dr. Allen at High Beach, which are licensed, and also
a cottage which is not licensed, but to which patients are
nevertheless sometimes removed.* These houses, at the
times of our visiting them, were not in a good state of
repair.

At our second visit, in 1843, to the house of Mr. At Mr. Ogil-
Ogilvie, at Calne, in the County of Wilts, we found that ■yi^-j*'^'^ '
he was in the habit of receiving from time to time, a gentle-
man without certificates, who had been previously confined
in his House as a Patient. This practice was objected to by *

us in the Visitor's book, and the Visiting Magistrates, on
two subsequent occasions, expressed their entire concur-
rence in our views upon this subject. At our fourth visit
to this House, in April, 1844, there were three persons,
who it was said were not Insane, residing in the house as
boarders. One of these persons was the gentleman who had
been previously confined under certificates at Mr. Ogilvie's,
and another was a person who had been a certified Patient
in two other Houses, and who, if not positively Insane, was
in a very doubtful state of mind. He had quarrelled with
his own relations, w^ho are highly respectable, and he ex-
pressed a desire to be reconciled to them. The person
and property of this individual both seemed to be under
the control of a solicitor, and we regretted that he was
not under the care of the members of his own family.
Mr. Ogilvie advertises, that he receives Nervous as well
as Insane Persons in his establishment.

Houses which are Licensed for the reception of Insane Nervous persons
Persons, ought to be kept exclusively for that purpose ; received in

and the reception of nervous, imbecile, and dejected per- Houses licensed^

for the Insane,
sons, amongst those who are Insane, and often dangerous,

is for obvious reasons open to serious objection. The

admission of such persons without orders and certificates,

* This cottage has since been included in the license granted is
October, 1843.

38-

appears, however, to be contrary to law, and is assuredly
liable to great abuse. The practice is, or may be, made
a subterfuge for receiving, as nervous, those who are
manifestly of unsound mind. In the Houses above
noticed, some of the boarders had been previously in
confinement as certified Patients; one of them sub-
sequently became maniacal, and was removed to another
Licensed House ; and others were manifestly Insane at the
periods of our visits. The great object of the Laws for
the regulation of Licensed Houses is, to insure to every
person confined in them the advantage of being regularly
♦ visited, and thus to provide a security against improper

acts, affecting either the person or the property of the
Insane. Every individual confined under certificates is
examined by official visitors, whose duty it is to satisfy
themselves not only that he is properly treated, but that
he is also a fit person to be detained ; and such investi-
gation is some protection against persons of unsound
mind being induced to make dispositions of their pro-
perty. It is questionable, whether a proprietor of a
Licensed House who receives boarders of this class, or
who permits deeds to be executed by persons who are
under confinement as Patients, ought to be entrusted
with a License.
Reasons for We have brought this subject before your Lordship's

bringina; the . . . , , tj j

subject forward notice, m a special manner, because Boarders, repre-
in a special sented to be of sound mind, have been removed from

manner.

several Licensed Houses upon our suggestions, whilst at
the Houses of Aspall Hall and at Calne, the practice of
receiving them has been persisted in, notwithstanding
our repeated remonstrances. Your Lordship is aware
that we formerly prosecuted a person for improperly
receiving insane persons as Boarders, and procured his
conviction and imprisonment, and that we have lately
applied to you for authority to visit Houses in which
Boarders have been illegally taken, with a view to the
prosecution of the Proprietors.

Dr. Finch at Laverstock, in the County of Wilts, Inegnkiitks at

Dr. Finch's,

occupies a private residence near to his JLicenaed House, Laveistock
but entirely separated from it. In this House, although Wilts;
it is not licensed, he has been in the habit of keeping
Patients. This practice has been objected to by us as
irregular, and Dr. Finch stated at our last visit, that the
Clerk of the Peace thought the objection would be
done away with by merely inserting in the next
License the word "Houses" instead of "House." By the
22nd section of 2 & 3 Will. IV. c. 107, such a License
would be invalid. Dr. Finch has also another House
in Salisbury which is not Licensed, but in which he has
admitted that he sometimes had more than one Patient.
These practices are irregular and very objectionable.

The Asylum at Cranbourne, in the County of Dorset, Asylum at

11 • • 1 . • 1 1 1 • 1 • ^1 Cranbourne,

has been visited three times. At the third visit, on the Dorset •
11th of Oct., 1843, the Proprietor was absent thirty
miles from Cranbourne, having left home on the Tues-
day, and not being expected to return until Friday.
There was no Superintendent, Keeper, or Nurse, to
take charge of the Patients, and there was only one
female servant, and a boy, sixteen years old, in the
House. We wgre told that there was a farming man
who might be sent for, in case any of the Patients should
be violent. A female who resides in an adjoining House
comes to the Asylum daily, and presides at meals, and
assists in the Establishment. There was also a Female
who had been a Patient, and was still a Boarder in the
House, who assisted in the management of it. The
Proprietor of this House has not been at home at any
one of the visits of the Commissioners. If the engage-
ments of the Propi-ietor of an Asylum take him so
frequently, and for long periods, from home, some
responsible and competent person ought, we think, to
be left in charge of the Patients,

At Ringmer, near Lewes, in the County of Sussex, Ringmer, near
a female is permitted to be almost entirely without ^^^^'^^j Sussex;

Halstock,
Dorset ;

Belle Grove
House, near
Newcastle ;

Led don,
Norfolk,

Medical Journal
often neglected.

clothing ; and although the Patients seem to be kindly
treated, the House requires great improvement. At
Halstock, in the County of Dorset, the Proprietor seems
kindly disposed towards his Patients; but the rooms
occupied by two of them have been reported upon
at our dijfFerent visits as defective in every respect.
At the last visit, they were described as low,
dirty, and without any furniture except a wooden
bedstead.

At Belle Grove House, near Newcastle, more restraint
has been found in practice than is met with in well
conducted Houses, and the Establishment is not in a
good condition, nor under proper management. The
beneficial interest in this House appears to have been
transferred to the gentleman who now has the License,
either as a Creditor, or as a Trustee for the Creditors of
the former Proprietor.

The state of the Licensed House at Loddon (in
Norfolk) has been reported anything but satisfactory
or creditable. The apartments in general are small, low,
and ill-ventilated, and the whole House dilapidated and
cheerless. One place, which is used by two Male
Patients as a sitting-room, is very objectionable. In
this House, little provision appears to be made for the
comfort or cure of its unfortunate inmates. Although
the Magistrates who visit it generally make favourable
Reports upon its condition, it has been found on our
visits in the condition above described.*

In many Licensed Houses receiving Private Patients
only, and in some also receiving Paupers, the Weekly
Medical Journal, required to be kept by 2 & 3 Wm. IV.
c. 107, sect. 33, has been altogether neglected. In some
cases, the Proprietors, being Medical men, have con-
tended that they are not required to keep such a journal.

* Very recently, and since this Report was prepared, the House has
been again visited by two of the Metropolitan Commissioners, who
state it to be now somewhat improved.

There is, in our opinion, no ground for this construc-
tion ; a journal being required to be regularly kept
in every house, without exception, which is licensed for
the reception of Insane persons.

We now proceed to notice those Houses which,
although they admit private Patients, are more parti-
cularly devoted to the reception of Paupers.

Amongst the provincial Houses which are licensed to Provincial

_, , , , , , ^ T-' • r J Houses licensed

receive Paupers, the best-conducted are those at tairiord, ^^ receive

Market Lavington, Devizes, Newcastle (Drs. Smith paupers.
and Mackintosh), Bensham and Dunston Lodge, near
Newcastle, at Hull (the Refuge), and at Droitwich.
The Proprietors of the Houses atFairford, Market
Lavington, Dunston, and Devizes, occupy farms and
land, which afford employment for their Paupers : but
it may be doubted if the Houses at Bensham and New-
castle, and the Refuge at Hull have sufficient ground for
the employment of the Patients. The yards be-
longing to these last-mentioned Establishments, with
few exceptions, are confined. In some of these Houses
improvements have been made, and in others, altera-
tions are in progress, which are quite necessary. The
alterations at Bensham are very extensive. We have been
desirous, on the ground of expense, not to press alter-
ations too hardly upon the Proprietors. The Establish-
ments at Newcastle and Hull belong to Medical Men.
The Proprietors of the Houses at Fairford, Market
Lavington, and Devizes are not Medical Men, but have
Resident Physicians or Apothecaries. The Diet in all
these Houses is good, and in some of them very liberal.

We have observed that Houses which have been for- Asylums for-
merly private Mansions frequently require extensive houses.
alterations, to make them fit for Asylums : that the
Mansion is sometimes engrossed by the Proprietor, his
family, and a few Private Patients ; and that the Paupers
are consigned to buildings which were formerly used as
offices, and out-houses. Of this description are the

Houses at Lainston, and Nursling, in the County of
Hants, Bailbrooke, near Bath, Plympton, in the County
of Devon, Derby, and Duddeston, near Birmingham.
The House at Duddeston has only one dull Yard for the
Male, and one, for the Female Paupers ; and at Bail-
brooke, there was, until very lately, and even after we
had remonstrated on the subject, only one Yard for the
alternate use of the Male and Female Paupers ; the
Males had no day-room, except the confined space in a
narrow sleeping-gallery, and some of the Paupers still
sleep in a cellar-like place on the basement story,
which we consider unfit for such a purpose. These
Establishments possess the means of affording their
inmates exercise in their Gardens and Grounds, but we
have not satisfied ourselves that they are allowed a suf-
ficient use of them. Although we consider the Houses
at Bailbrooke and Duddeston, in their present state, to
be ill-adapted for the care of Pauper Lunatics, we think
that the Proprietors treat their Patients with kindness.
System adopted Two Licensed Houses, namely, those at Duddeston
and Hil^ea in ^^^ Hilsea, deserve particular notice on account of the
connection with manner in which they have been established and carried

Workhouses,

on in connection with Workhouses, which send to them

only their unmanageable Patients, and afterwards remove

them when they become tolerably tranquil, without

reference to the propriety of their remaining at the

Asylum, for the purpose of cure.

As>lum at The Asylum at Hook Norton, in the County of

oT rd hi' °°' Oxford, has lately been taken by a Medical Gentleman,

who appears disposed to make improvements ; but at

present some of the Yards are small and dull.

Fisherton The accommodations for the Paupers at Fisherton

huTY^' ' ^ '^' House, near Salisbury, require great alteration and

improvement. The Proprietor has lately purchased some

land adjoining the House, and states his intention to

make additions to his premises, which are quite essential. —

Some of the apartments at the Licensed House at Gates-

head Fell, near Newcastle, were very defective ; but con- Gateshead Fell,
siderable improvements have been lately made in them, at '

our suggestion. — The House at Gate Helmsley, near Gate Helmsley,
York, is, in its interior, commodious, and well adapted " '

for an Asylum, having been built expressly for the pur-
pose. The Yards, however, are extremely gloomy and
confined. The Proprietor is desirous to improve them,
but there are local difficulties. — The House at Dun- Dunnington,
nington, near York, is of an inferior description: until '

very lately there was only one Airing Court for the
Males and Females, and the Males were consequently
locked up during a great part of the day. Some of the
sleeping-rooms in this house are very bad.

The parts of the Workhouses at Morda, near Os- AVorkhouscs at
westry, in the County of Salop, and at Stoke Damerel, ^Jg^oke^"^'
near Plymouth, which are Licensed for the reception of r)amere],
Insane persons, are extremely ill-suited for the purpose.
The Patients at Stoke Damerel are, however, under
excellent management. — At the Licensed part of the
House of Industry at Kingsland, near Shrewsbury, Kingsland, near
containing from eighty to ninety Insane persons, they ^ " y >

were nearly all fastened to their beds at night by chains
to the wrists. In consequence of our remonstrances,
this restraint has been in a great measure discontinued.
— The Licensed Workhouse at Carisbrooke is much Carisbrooke.
improved, and has very good accommodation for the
Patients, and good grounds and Yards for exercise. It has
never been the practice to detain any curable persons
at this Workhouse.

There are four Houses in the Metropolitan District Asylums in

. . 1 • T« • 11 Metropolitan

receiving Paupers and private Patients ; namely, the District :

Asylums atHoxton and Peckham,and the Red and White

Houses at Bethnal Green, which adjoin each other. The Betlmal Green ;

one is appropriated to Males and the other to Females.

The premises comprise about nine acres of land, and

are in a populous neighbourhood : not more than two

of these nine acres are used for the out-door employment
of the Male Paupers. The Houses were, until lately,
old and inconvenient, and the yards not well arranged.
Almost the whole of the Buildings, however, are in the
course of being taken down and rebuilt, and the Esta-
blishment is undergoing extensive improvements. We
have visited few, if any, receptacles for the Insane, in
which the Patients are more kindly or more judiciously
treated than in these two Houses. The abuses which
existed in this and some other Asylums, previously to
the year 1828, led to the introduction of the system of
Visitation by Commissioners in the Metropolitan district.
The Houses at Bethna) Green which were amongst the
worst, now rank with the best receptacles for the Insane.

Hoxton House; The Asylum at Hoxton is situate in a densely-
crowded neighbourhood : the Yards are dull and confined,
and the internal accommodations are inconvenient and
defective, and it has no land whatever for employing its

Peckham Paupers.— The Peckham Asylum has great advantages

"^^' over those at Bethnal Green and Hoxton, in its site and

grounds, and the internal accommodations are in general
good. This house, however, has always been a source of
trouble to us, upon the subject of its diet. It has, on
several occasions, been specially visited on this account,
and frequent remonstrances have been made. Applica-
tion has been lately made for licensing the House for
the reception of a larger number of Patients. The grant
of the License, however, has been delayed, until we shall
be satisfied as to the diet of the Pauper Patients. — It
may be asked, perhaps, if we have not been too lenient
in renewing, from time to time, the Licenses for the
Peckham and Hoxton Asylums. Your Lordship, how-
ever, must be aware, that in consequence of the deficient
accommodation in Public Asylums, if Licenses were
withdrawn from Houses containing large numbers of
Paupers, there would be no alternative, but to send the

Patients to Workhouses, or to board with other Paupers,

where they would not have the care which they now

receive under regular visitation and supervision.

Many of the Licensed Houses are the freehold of the Influence of

Proprietors, and others are held upon lease, and some (.g"gg^ Houses

only by tenancy from year to year. We notice this o° improve-

ments involving
circumstance, as it of course influences the adoption or expense.

rejection of any improvements that may be suggested
by us, which involve much expense.

It is only fair, to state that very important and exten- Improvements
sive improvements have been already made in several Asylums.
of the Licensed Houses since the commencement of our
visits. Additions to the yards, grounds, and buildings
have been made at the Houses at Gateshead Fell,
Bensham Asylum and Dunston Lodge, near Newcastle,
at Bailbrook House, near Bath, at Laverstock, near
Salisbury, at Carisbrooke, in the Isle of Wight, at
Belle Yue House, Devizes, and at Fairford • but other
improvements are still requisite in some of these Estab-
lishments. In many of the other Houses which we
have noticed, and in some others which we have not
remarked upon, some alterations are essential. We have
found, in a few Houses and Asylums, a practice of per-
mitting two men to sleep in the same bed, and in
many Houses and Asylums of allowing only two men
to sleep in one room. This practice has been discon-
tinued at the York Asylum, and at Newcastle (Smith
and Mackintosh's), at Hanwell, and in many other
instances, upon our suggestion. At Dunston Lodge,
the practice is still continued, notwithstanding our
remonstrances ; and it still continues also at the Chester
Asylum ; although alterations have been lately made
there, we believe, in some of the rooms (which are
capable of holding two beds only) at our suggestion.

Ha vei ford west ;
Commissioners'
Report in 1842,
recited. — Asy-
lum formerly a
gaol.

Number of pa-
tients in 1842,

Extreme defi-
ciency of com-
fort and con-
venience.

6. Abuses and Defects.

Having thus called your Lordship's attention to the
Asylums of all classes which have partial defects, it is
now our duty to bring under your consideration the
condition of the Asylums and Licensed Houses which
deserve almost unqualified censure.

The Asylum at Haverfordwest was first visited by the
Commissioners on the 13th of September, 1842. Their
Report states that this Asylum was formerly a small gaol,
for the criminals of the town, but was (in 1822), by
virtue of an Act of Parliament, appropriated to the re-
ception of Lunatics. It did not appear that any addition
or alteration whatever had been made, so as to adapt it
to the accommodation of patients. On the contrary, all
the ^cells and rooms were apparently in their original
condition, not even windows having been added, except
in the part which faces the public street.

The Asylum, at that time, (1842,) contained eighteen
Patients, nine being Males and nine Females ; and the
Corporation of Haverfordwest contracted with a person
to supply the Patients with food and other necessaries.
The Commissioners felt it their duty to report that
the Asylum was deficient in every comfort, and almost
in every convenience; the rooms being small and ill
ventilated, some of the lower rooms (originally cells
for Prisoners), being almost dark, and the interior of
the Asylum altogether out of repair. The two day
rooms, in which the less violent Patients were confined,
(one having seven Males and the other five Females),
each measured about twelve feet by nine feet : the floors
were of soft stone, but parts of it (in the Female
ward considerable parts), had been torn up and
destroyed. There was no seat, or table, or any article of
furniture in the Women's Room, and nothing, except a
table, in the Men's Room. The Men were standing; the

Women standing or sitting on the floor. On the cir-
cumstance being noticed by the Commissioners, a long
board or seat was brought into the Men's Room from the
airing-ground, and fixed against the wall. It was not
sufficient for the seven Male Patients who were in the
room to sit on. Four of the Men, however, sat down
on it ; the others remained standing. In the airing-
ground belonging to the Women, there was a bench,
which apparently belonged to their Room. There were
large holes in some of the walls and ceilings. The
airing-courts were very small and cheerless, particularly
that belonging to the Men, and they were both strewn
with large stones, which had fallen or been forced
from the Building. There were two mischievous
Patients, unrestrained, amongst the Men, (in whose
hands these stones might be formidable weapons,) and
another fastened in a chair, in a separate room or cell.

The dress of the Patients was, in almost every Bad state of
instance, dirty, ragged, and insufficient. One of the ^ ° "^^'
Female Patients pulled off her shoes and stockings,
.which were nothing more than rags, such as are
occasionally seen on heaps of rubbish. The Com-
missioners were informed that there was not a single
change of linen (either for the beds or for the person),
throughout the Asylum. This fact was complained of
by the Matron. Indeed, the Commissioners could not
discover any linen whatever, except upon the persons
of some of the Patients, and the dirty cases of the straw
beds, throughout the House. There were only sixteen
single beds for the eighteen Patients confined in the
Asylum. One Patient (a Boy of nineteen) slept on
loose straw, on the stone floor, in a small dark cell; and
one other Patient (a Girl), who was convalescent,
slept in the same room with the Keeper and his W^ife,
on a bed belonging to them. She must otherwise
have slept upon the floor, and apparently without
bedding.

Want of bed-
ding.

Restraint.

Want of exer-
cise and employ-
ment.

The Commissioners cause4 many of the beds to be
uncovered, and found that there were no sheets
or blankets, and little more than a single rug to cover
the Patients. In more than one instance, the scrap
of blanket (allowed in addition to the rug) was insuf-
ficient to cover half the person. The beds were of
straw, and almost all of them were inclosed in coarse
linen cases; but although there were several dirty
Patients, there was not more than one case for
each bed. Some of the cases were soiled, and all of
them appeared dark, as if from long use. The Matron
stated that she had applied repeatedly for more bed-
clothes and for linen, but without effect ; the Contractor
would not send them. She complained to the Commis-
sioners, that the state of the Asylum (in reference to its
want of repair, comfort, and accommodation, and the
destitute condition of the Patients) was dreadful ; and
she expressed her earnest hope that some person would
speedily interfere on behalf of " the poor creatures con-
fined there."

In regard to restraint, the Commissioners found that
no belts, hand-locks, or strait-jackets were allowed,
but the refractory Patients were confined in strong chairs,
their arms being also fastened to the chair. Two were
thus confined, separately, in small rooms, into which
scarcely any light entered through the gratings. One
was the Boy before mentioned, who slept at night on the
floor of the same room ; the other was a Woman who was
entirely naked, on both the days on which the Com-
missioners visited the Asylum, and without doubt during
the whole of the intermediate night. Both these were
dirty Patients. In the Woman's room, the stench was so
offensive, that it was scarcely possible to remain there.

During wet weather, there was no place whatever for
exercise ; and at other times there was not sufiicient
space for the purpose. No attempt was made to employ
any of the Patients, and no books or other amusements

were provided. Prayers were never read, and no Cler-
gyman ever visited the Asylum, although one of the
Female Patients, who was occasionally depressed, and
imag-ined that she had not done her duty to a child who
had died, appeared especially to require such consolation
as a Clergyman might afford.

The Keeper and his Wife (the Matron) appeared well- Allowance to
disposed towards the Patients, but they were themselves ^f^^
scarcely above the rank of Paupers. They were allowed
the same rations as the Pauper Patients, and a salary of 20^.
a year, between them. They had no assistant or servant,
for the purpose of keeping the Asylum or the Patients
clean, for cooking the food, for baking the bread, or for
any other purpose connected with the Establishment.
At our first visit, the Keeper was absent. The Commis-
sioners were informed that he was at work for some
person in the neighbourhood.

The Patients were allowed water only for their Insufficient pro-
drink; culm and clay for firing; straw (chopped and
whole) for the beds — of the clean as well as of the dirty.
The bread was dark and heavy, and was made of barley-
meal and wheaten flour. The Matron said that the
yeast allowed was insuflScient, and that the oven was
out of repair, and that consequently she could not make
the bread good or wholesome. She had repeatedly
complained of these things without effect.

As evidence of the spirit in which this establishment Bad spirit
was upheld, the Commissioners were informed that a few manaKement.
years ago a person was directed by Government to exa-
mine the buildings constituting the Asylum, and that,
some notice being had of his expected arrival, work-
men were employed during the whole of the preceding
night upon the repairs, so that when the Governmen
Agent visited the building in the morning, he found it
Undergoing repaii:. These repairs, however, were discon-
tinued immediately after the Agent left the Asylum, and

Record of Com-
missioners'
opinion in Ma-
gistrates' book.

Case of Haver-
fordwest
brought before

have never since been proceeded with. These facts were
stated to the Commissioners by the Matron.

As the Commissioners had no opportunity of seeing
any of the County Magistrates, they thought it advisable
to make the following entry in the book kept at the
Asylum, in order that their opinion might be known : —

" The undersigned Metropolitan Commissioners in
Lunacy have this day visited this Asylum, which, they
regret to observe, is deficient in almost every comfort and
accommodation which a Lunatic Asylum should possess.
The place imperatively requires repair and enlargement.
There is a deficiency of bedsteads, of seats, of wearing
apparel, and a great and most culpable deficiency of Unen
and bedding.

" They think it their duty to call the attention of the
Magistrates of this district to the miserable condition of
the poor persons confined in this Asylum, and to urge
their immediate interference in their behalf.

" They suggest that some employment should be pro-
vided for the Patients ; that prayers (which are now never
read) should be read regularly; that means should be
afforded of dividing the violent from the tranquil Patients;
and that larger rooms and more extensive airing-grounds
should be provided. They beg further to suggest that a
liberal contract for the supply of food and clothes, &c.
to the Patients, should be entered into and eyiforced upon
the contractor, who at present appears to be irregular in
his supplies, and to be disgracefully inattentive to the
applications which the Commissioners understand have
been made to him, for the supply of clothes, linen, and
beds to the Patients.

" The Medical Superintendent is requested to com-
municate these observations to the Magistrates of the
district, and to entreat their attention to them."

On the 3rd of November, 1842, being the first quar-
terly meeting of the Metropolitan Commissioners that took

place after the Asylum of Haverfordwest had been visited, Metropolitan
the case was brought before the Metropolitan Board, and
they resolved that the opinion of the Law Officers of the
Crown should be taken as to " the parties amenable for
the great and cruel abuses existing in this Asylum."
They also ordered a copy of the Visiting Commissioners'
Report to be sent to the Lord Chancellor, and to the
office of the Secretary of State for the Home Department,
accompanied by a letter, intimating that the importance
of the case had induced the Metropolitan Commissioners
to take the opinion of the Law Officers of the Crown.
The copies of the Report were accordingly sent, and on Communication
the 28th of January, 1843, Sir J. Graham acknowledged S^y^orState?"
the receipt of the letter sent to his office from the Metro-
politan Board, and enclosed a letter from Mr. Leach,
Chairman of the Quarter Sessions for the County of
Pembroke, relative to the care and custody of the Luna-
tics in the Haverfordwest Asylum. On the 7th of
February, 1843, Sir J. Graham wrote to the Metro-
politan Board, requesting to have the opinion of the Law
Officers of the Crown as to this Asylum, when it should be
obtained. In the meantime, a case, stating the facts,
accompanied by a Report of the Visiting Commissioners,
had been laid before the Attorney and Solicitor-General.
After some time the opinion of the Attorney- General was
obtained ; but upon perusing it, it was found necessary to
call his especial attention to some points arising out of
the case, and a conference subsequently took place be-
tween him and the Solicitor-General ; and on the 30th of
May, 1843, they gave their joint opinion that the " cause Opinion of Law
of the state of the Asylum appeared to be the neglect and Officers.
want of attention on the part of the Justices of the Town"
(of Haverfordwest) : but that it was difficult to say
that there had been any breach of the provisions of any of
the Acts of Parliament, which could be the subject of legal
proceedings. And they concluded by recommending
"that a strong remonstrance and representation should
e2

be made to both the Justices of the Town and of the
County of Pembroke ;" and by saying, that if the Jus-
tices of the Town had not made a Code of Regulations
for the Asylum, they might be compelled to do so, by
mandamus.

Second Report At the second visit made to this Asylum, in August,

of Commission- ,„,„,„ .. ,1.1^

ers, in 1843. 1843, the Commissioners reported that some improve-

Asylum wholly ^^gj^j. y^^^ j^gg^ made, but that the great want of accom-
unfit for treat-
ment and care modation in the Asylum, and the very narrow dimensions
of Insane. ^^ ^^^ ^^^^^^^ almost precluded the possibility of pro-

viding the Patients with suitable occupations or amuse-
ments. Occasionally, one or two of the Patients, it
appeared, were taken out for a walk into the town ; and
within the precincts of the Asylum, a few of the women
sometimes assisted a little in the household work. A
Surgeon, practising in the town, visited the House
once, and occasionally twice, a week ; but the Commis-
sioners could not find, from any of the documents;, that
he made any Reports or Entries relative to the Patients
or the Asylum. It appeared that the House had then
lately been visited weekly, by the Mayor or one of the
Magistrates of the Borough, and sometimes by both,
accompanied by a Police-Constable. The arrange-
ments regarding the diet appeared to the Commissioners
to be on a scale of extreme parsimony ; and they con-
sidered that although symptoms of some improvement
were manifest the place was wholly unfit for the treat-
ment and care of the Insane.
State of St. The part of the Bristol Workhouse called St. Peter s

Peter's Hospi- Hospital, set apart for the Pauper Lunatics of the city,

tal, Bristol. r » f r j ■>

is without any day-room, eating-room, or kitchen, for the

Females, distinct from their sleeping apartments ; and

the only place in which they (40 in number) can take

exercise is a small passage or paved yard at one end

of the Hospital. It is part of the road for carts to

the Workhouse, and measures about thirty-seven feet

by eighteen, and is, from its pavement and extent

utterly unfit for an airing-ground. The accommodations
for the men are somewhat better, but they have only part
of a paved yard, very little larger than that appropriated
to the Females. The Workhouse itself is in the centre
of the City of Bristol, and is totally unfit for an Asylum
for the Insane. There are no means of classification, of
exercise, or employment. Praise, however, is due to the
Medical and other Officers of the house, for the attention
paid by them to the Patients, considering the means at
their disposal. There were small wooden closets, or Pens,
for confining the violent and refractory Patients. Those
for themen were seven feet long by threefeet three inches
broad, and about nine feet high, and were warmed by
pipes, and had a hole in the door, and also a hole in
the ceiling for ventilation. The Pens for the Women
were smaller and were not warmed, and were ill-venti-
lated. The walls of each were of wood, but not padded.
Formerly, Patients were occasionally kept in those Pens
during both day and night, but the Pens are now very
rarely used. The entire body of Lunatics ought to be
removed to more spacious premises, and to a more
airy and healthy situation. In addition to the jacket
and leg-locks, a sort of open mask of leather passing
round the face, and also round the forehead to the back
of the head, and fastened by leather straps, was at one
time placed over the heads of such Patients as were in
the habit of biting; but this mask (as the Commis-
sioners understand) has been for some time disused.

At the Asylum at West Auckland, first visited on the State of Asy.
5th of December, 1842, there were 13 Males, and 16 ^^^land^*
Females. Each sex had only one sitting-room, with
windows that did not admit of any prospect from them,
and the violent and quiet, and the dirty and clean were
shut up together. There was only one small walled
yard, and when the one sex was in it, the other was
locked up. One of the Male Patients said that they were
made so tender by their confinement that their health

was destroyed. There were two small grass closes belong-
ing to the House, but they appeared to be little used
for the employment of the Males. In the small, cheer-
less day-room of the Males, with only one unglazed win-
dow, five men were restrained, by leg-locks, called hobbles,
and two were wearing, in addition, iron hand-cuiFs and fet-
ters from the wrist to the ankle : they were all tranquil.
The reason assigned for this coercion was, that with-
out it they would escape. One powerful young man,
who had broken his fetters, was heavily ironed, and
another was leg-locked and hand-cuffed, who was under
medical treatment, and in a weak state. One woman was
leg-locked by day and chained to her bed at night. Chains
were fastened to the floors in many places, and to many
of the bedsteads. The Males throughout the House
In Commis- slept two in one bed. The Commissioners who first
unfit for Insane visited the Asylum, stated their opinion to be, that it
Persons. -^g^^ entirely unfit for the reception of Insane Persons.

It was also visited on the same day by two Magistrates,
who entered the following Minute in the Visitor's
Book :—

5th December, 1842.
Report of Visit- " We this day visited the Asylum, and found that
on^dayofCom- the Commissioners had just left it. We found every

missioners' first tJjjjj- j^ „qq^ order."

visit. ® °

Three Magistrates, with one Medical Attendant, on
the 24th January, 1843, entered the following Minute
in the Visitor's Book : —

2ith January, 1843.

" Visited this House and found everything in proper
order, and the House in a clean state."

Second visit of On the 16th of May 1843, two other Metropolitan

to^WesTAuck- Commissioners visited this house and found the Patients

^'"^*^' all locked up in their day-rooms, with the exception of

two or three who were employed about the House ; the

restraint had been removed from all the Patients but

one, without accident or inconvenience of any kind, but
the House was in the same state in which it was at the
previous visit. The Patients were listless, without amuse-
ment, occupation, or exercise. The Medical Attendant
considered that "bleedings, blisters, and setons" were the
principal resources of Medicine for relieving- Maniacal
Excitement. The Asylum was visited a third time by
different Commissioners, on the 27th day of August, Commissioners'
1843; and lastly, on the 19th of April, 1844; and the ^^^f/"** ^*'"''''
several Commissioners, on both occasions, reported that,
notwithstanding some alterations and slight improve-
ments made in consequence of their suggestions, they
concurred entirely in the opinions repeatedly expressed
by the other Metropolitan Commissioners, as to the
total unfitness of these premises for a Lunatic Asylum.

At the Wreckenton Asylum near Gateshead, first State of Wreck-
visited on the 2nd of December, 1842, the day rooms, neaJ°GttS3.
of which there are three on the Male side, and the same
number on the Female, were confined and gloomy.
Chains were attached to the floor in several places, and
it was the practice to chain Patients by the leg, upon
their first admission, in order, as it was said, to see
what they would do. In a small dirty room or cell, on the
Male side, in which a Patient was placed at night, was
observed a heavy chain attached to the wall, by which
it was admitted that a Man had been confined within
the last twelve months. The bedding was in a filthy
state, and the cell very offensive, as were also most of
the sleeping-rooms and beds throughout the house. The
whole place was in bad order ; and the Male Patients
especially presented a ragged and uncleanly appearance
and were listless and unemployed. The Females were
in a better state, in regard to clothing, and some of them
were employed in needle-work. An old Woman, who
had attempted to commit suicide, was, at the time of our
visit, on that account chained by the leg to the fire-
guard, and she was stated to be usually fastened in a

similar manner to her bed at night. This place was
visited again the next day, when the benefit of our en-
quiries was manifest ; the whole bouse having apparently-
been cleaned in the meantime, and fresh linen placed
upon the beds. The Commissioners considered the
premises in their then state unfit for an Asylum. The
Commissioners' second visit to this Asylum was made on the 17th of
May, 1843, by two other Commissioners, and although
some improvements had been effected, and others were
in progress, they considered that the place was still not
a proper Receptacle for Lunatics. At the third visit,
in August, 1843, the place was clean, and the Patients
tolerably comfortable : at the last visit, in 1844, the
Commissioners considered that, although considerably
enlarged and improved, it was, in many respects, still
unfit for an Asylum.

State of At the Licensed House at Derby, first visited on the

Licensed House r r>. t in • i -r. i

at Derby. 21st of October, 1842, the straw in the Paupers beds

was found filthy, and some of the bedding was in a dis-
gusting condition from running sores, and was of the worst
materials, and insuflScient. Two Cells, in which three sick
epileptic Paupers slept, were damp, unhealthy, and unfit
for habitation. The beds of some of the Private
Nearly all the Patients were in an equally bad state. Nearly all the
Jaw violated. provisions of the Law for the regulation of Licensed
Asylums were violated. A lady was found confined in
Case of a this House, who was represented to be a Visitor, and not

sented to be a ^ Patient, but who, upon investigation, was proved to
Tisitor. have been brought to this House from another Lunatic

Asylum, where she was a certified Patient. Her name
was entered, in the Private Account Book of the Proprie-
tor, as a Patient, and he had given a Certificate that she
was confined in his Asylum, for the purpose of author-
ising her Trustee to pay over to her husband dividends
to which she was entitled, only a few days previously to
the visit of the Commissioners. The Magistrates of
the Borough, who are its Visiting Justices, had not

visited the House for the space of a year, minus eight
days. This lady had been, during- the whole of her resi-
dence in this place, from the month of May until Octo-
ber, anxious to see some Magistrate, with a view to
demand her liberty. She was afterwards liberated upon
our remonstrances. This Asylum was found in a better Commissionere'
state at the second visit, but when visited for a third
time, on the 18th of October, 1843, it was again in a
very bad state. The Paupers were still occupying what
had been the coach-house and stables. The Cells, which
had been objected to, were not used, but the male Pau-
pers (fifteen in number) were sleeping in the upper floor
or loft. One room, measuring seventeen feet long by
nine in width, had four beds, two rooms had two beds
each, and there were four single rooms, only six feet six
inches by six feet. Three beds were placed in the com-
mon passage. The rooms were low, comfortless, and ill
ventilated. An Epileptic was in bed in a dying state,
and the windows and door of his room being closed, and
there being no opening or other means of producing a
free circulation of air, the apartment was most offensive.
Some sawdust had been thrown upon the floor to absorb
the urine, but nothing had been done to purify the air,
— ^This Asylum has lately been transferred to another
Proprietor.

The Asylum at Lainston, in the County of Hants, State of Asylum
was first visited on the 14th of October, 1842. The Hants, '
Buildings appropriated to the Paupers consisted of
stabling and out-houses converted to that purpose, and
were quite unfit to be used as an Asylum. At the
second visit, these evils were so manifest, that the Commissioners'
Visiting Commissioners expressed a hope that means ^^'^^^ ^^''*
would be found to put an end to them, either by refus-
ing the license, or otherwise. At the third visit, on Commissioners'
the 22nd of August, 1843, the house was found altoge-
ther in a bad state. The rooms on the ground-floor,
both for the Males and Females, were in an extremely

filthy condition. Seven Female Paupers were restrained

with iron hand-locks and chains, and strait-waistcoats ;

and the same seven Women, and three others, were

chained to their beds at night. We expressed our

Use of hand- strong disapprobation at the use of hand-locks and

chains, chains, but the Proprietor said that he employed them

because they were essential to safety. Previously

to the third visit, this house had been several times

visited by the Magistrates. They had entered in

Magistrates' re- the Visitor's Book, at one visit, a remark, that the

marks in Visit-

or's book. sleeping-rooms for the dirty Male Patients, and for the

Females on the ground-floor, were " unwholesome and
damp ;" and that the clothing of one of the Patients
was scanty and insufficient ; at another visit, that the
yards of the Females were wet and filthy ; and, at
a third visit, that there was no classification, and that
their previous recommendations upon this head were
unattended to. The Paupers in this House are toler-
ably well-fed, but have been always found dirty and ill
Commissioners' clothed. It was visited again in April, 1844, and was
still in so indifferent a state, that the Commissioners again
repeated their opinion as to the urgent necessity of erect-
ing a Public Asylum for the county.
State of House With regard to the house at Nursling, in the same
Hants. County, the Commissioners, who first visited it on the

12th of October, 1842, reported that the Buildings ap-
propriated to the Paupers had been offices, and were in
a dilapidated state. Their construction was bad, and they
could not, in the Comnaissioners opinion, be made comfort-
able. The rooms were small and close, and the airing-
Commissioners' courts extremely limited in point of space. The Commis-
sioners who next visited this Asylum, on the 25th
day of June, 1843, made a similar Report, and objected
that the main part of the house, as at Lainston,
was reserved for the Private Patients and the family of
the Proprietor, and that the out-buildings were set apart
for the purpose of receiving Insane Paupers, without

much consideration as to their general comfort or even-
tual cure. At the third visit, on the 24th August, 1843, Commissioners'
a similar Report was made, and the bed-rooms for the
dirty classes, both of the Male and Female Paupers,
were offensive and confined, and had unglazed windows,
and only wooden shutters, as a protection against the
outer air.

Kingsdown House, at Box, near Bath, was first State of Kings-

. down House,

visited in September, 1842. Amongst its great defects, Box, near Bath,
is the want of airing-grounds. The space allowed for
exercise, considering the number of Patients, is wholly
insufficient. One of the wards, in which were fifty
Female Paupers, had only a very small yard attached to
it, and' this, being on an abrupt descent and uneven
throughout, was not only unfit for exercise, but was
insufficient for half the number of Patients ; and they
were consequently congregated in a small room at one
extremity of the yard. Every seat there was occupied,
and the room itself being ill- ventilated, there existed an
offensive odour that must have been detrimental to the
bodily health of the Patients. The airing courts for the
Females is surrounded by very high walls, and is dull and
cheerless, and the only yard for the Male Paupers is but
little better. At the second visit, on the 18th of April, Commissioners*
1843, the straw-rooms for both sexes on the ground floor, ^^'^^^ ''^' *
were pointed out by the Commissioners as unfit for use.
There being only one day-room and one airing court for
each sex, the noisy, violent, refractory, dirty, and
dangerous Patients, were crowded together in the same
small space with those who were clean, convalescent and
quiet, and the noise and confusion were extreme. There
were seven Females under restraint; two had strait-waist-
coats, two had their arms fixed in iron frames, not allowing
the freedom of hand-locks, and three had iron leg-locks;
one Female was chained by her legs to a wooden seat in
a paved passage, to prevent her, as it was stated, hurting
herself in her fits. Eight or ten of the Females were

fastened by straps and chains to their beds at night.
One Male was chained by his leg to a seat in the yard,
and another Male was chained to his bed at night. At
Commissioaers' our last visit, on the 24th of April, 1844, a trifling
enlargement had been made in the yards, one of which
was covered with macadamized stones, but the House
was in the same unsatisfactory state, and the same
harsh and cruel system of restraint was in practice.
State of Asylum The Asylum at Plympton, in Devonshire, was first
Devon!^^ °^' visited in October, 1842, when ten persons were found
under restraint. One of them had been restrained for
two months, merely for breaking windows. From the
Complaints of Reports of the Visiting Justices, it appeared that com-
unattended to^'^ plaints had been repeatedly made of the state of the
Buildings, but apparently without any beneficial results,
as they were then in a very objectionable condition.
One room, in which seventeen Patients lived during the
day, measured only sixteen feet six inches by twelve feet.
There was no table in it, and there was sitting-room for
no more than ten Patients. Several of the bed-rooms
were cheerless and wet, from the damp or rain, and the
walls were besmeared with filth. Close to some small crib-
rooms, in which some Girls (violent patients) slept, there
was a bed-room for a Male Patient, who, it appeared,
had access to the room in which the Girls slept. At the
Commissioners' second visit, on the 14th of July 1843, the condition
visi . ^£ ^j^g Pauper Patients continued wretched in the ex-
treme. Some of the buildings, to which attention
had been directed by the previous Report, were in
the same objectionable state as then described; the
day-room being most offensive, and the airing-court
■comfortless, and rendered dangerous by a quantity of
loose stones scattered about. In a day-room, in a state
of furious mania, was a young woman, who had been
delivered of a child five or six weeks previously, con-
fined by a strait-waistcoat, and chained by the arm and
leg to a bench. Another Woman in this ward, in a strait-

waistcoat, was lying in a hole in the middle of the airing
court, without covering to her head, or anything to
shelter her from the broiling sun. Ten Curable Patients
and two Idiots were under the charge of a Lunatic, who
was himself confined by a chain from the wrist to the
ankle, at the arrival of the Commissioners, principally
to prevent him escaping: this chain was soon afterwards
taken off at his own request, in order that he might not
be seen, by the Commissioners, so restrained. The day-
room of this ward was extremely small, with an unglazed
window and no table. A series of sleeping cells for dirty
Patients, connected with this yard, were dark, damp, and
offensive : they were occupied at night by four Males,
two in one cell, and two in single cells. The dirty Male
Paupers slept in a room, formerly the dairy, in which
were six beds ; it was damp, ill ventilated, and offensive.
There was only one small window unglazed, which was
closed with a shutter at night. There were chains and
wrist-locks attached to nine of the beds on the Male
sidcj which were constantly used at night, partly to pre-
vent violence, and partly to guard against escape. Four
of the Female Paupers, represented to be subject to vio-
lent paroxysms after epilepsy, were ordinarily confined
to their beds by chains and wrist-locks.

At the third visit to this House, on Oct. 2, 1843, Commissioners
three Women were found chained by their legs to the *

benches. One of them, mentioned in the previous
Report, had, besides the chain to her leg, another chain
passing round her waist, to which were fixed, by an iron
ring, two hand-locks in which both her hands were con-
fined. Besides this restraint, there were twenty-one
Patients who were chained to their beds at night : two of
these were Private Patients, and the others were Male
and Female Paupers. The three sleeping-rooms in the
Women's cottage, could not, in the judgment of the Com-
missioners, have been cleaned for some days : the wooden
cribs were filthy, the floor was in holes, and soaked with

urine, and in parts covered with straw, and excrement.

We can give no other general description of it, than that

it was most disgusting and offensive. In a crib, in one of

these wretched places, a Female Private Patient who was

cleanly, had been compelled to sleep : she implored us

only to remove her to a better part of the House. The

remainder of the third Report of this House by the

Commissioners, is a detail of numerous other abuses.

Extract from The following is an extract from it : — '' In one of the

tWrd're^rt' on " ^^^'^ ^^ *^® Upper Court for the Women, the diraen-

Asylum at « sions of which were eight feet by four, and in which

Plympton.

" there was no table, and only two wooden seats, fast-
" ened to the wall, we found three Females confined.
** There was no glazing to the window, and the floor of
** this place was perfectly wet with urine. The two dark
" cells, which adjoin the cell used for a day-room, are
" the sleeping-places for these three unfortunate beings.
*' Two of them sleep in two cribs in one cell. The floor
" in the cell with the two cribs, was actually reeking
" wet with urine, and covered with straw and filth, and
" one crib had a piece of old carpet by way of bedding,
" besides the straw, but the other appeared to have had
" nothing but straw without any other bedding. In
" the other cell, the Patient who slept in it had broken
" her crib to pieces, and a part of it was remaining in the
" cell, but the straw was heaped up in one corner, and
*' as far as we could rely upon what was said, she had
" slept upon the straw, upon the ground, at least one
" night. The straw itself was most filthy, the floor was
" perfectly wet with urine, and part of the straw had
" been stuck to the wall in patches with excrement. It
" must be added that these two cells, and one other
" adjoining to it, have no window, and no place for
" light, or air, except a grate over the doors, which
" open into a passage. The persons of these three
" unfortunate Women were extremely dirty, and the
" condition in which we found them and their cells

*' was truly sickening- and shocking. Adjoining to the
" two sleeping-cells of these Women, and opening into
" the same passage, was a third cell which was occupied
'• as a sleeping-place by a Male criminal of very dan-
" g-erous habits, and an Idiotic Boy. This cell was
" dirty and offensive, and the floor of it wet with urine,
" but it was not in so filthy a state as the other two.
" The criminal was fastened at night to his bed with a
*' chain. We strongly objected to these Men being- con-
" fined in a cell closely adjoining- to the females. The
" whole of these cells were as damp and dark as an
" underground cellar, and were in such a foul and dis-
" gusting- state, that it was scarcely possible to endure
" the offensive smelL We sent for a candle and lan-
" tern to enable us to examine them."

So far from any good having- resulted from the pre- Comments on
vious remonstrances of the Commissioners, the House condition of the
was found, at this third visit, even in a worse condition ^°"^®'
than at the previous visits. The visiting Commis-
sioners stated, that in their opinion, it was highly dis-
graceful to the Proprietor to keep his Paupers in the
wretched condition in which they found them, and that
his conduct in this respect loudly called for some prompt
and effective interposition. This Proprietor received
10*. 6c?. per week for each Pauper, besides a guinea
upon admission. The Magistrates, who appear to
have formerly attempted to improve this House, had
not at our third visit inspected it since the last pre-
ceding visit of the Commissioners, and on the 2nd of
October, 1843, it seemed to have been visited only once
by the Magistrates since the 14th of October, 1842 ;
namely, on the 14th of June, 1843. We are decidedly
of opinion, that a person who keeps his Patients in the
disgraceful condition in which the Paupers tyere found
in this Asylum, ought not to be entrusted with the care
of Insane Persons.

The Asylum at Nunkeeling, near Beverley, in the State of Asy-

lum at Nun-
keeling, near
Beverley,
Yorkshire.

Commissioners'
second visit.

Discovery of
six concealed
sleeping places
on third visit
to West Mai-
ling, Kent.

county of York, first visited on the 10th of Sep-
tember, 1842, was found in an indifferent condition,
but the Proprietor promised to remedy the defects
objected to. At the second visit in 1843, uo alterations
had been made. The sitting-room and chambers
in which the Pauper Patients were lodged, and
the yards, the only places out of doors to which
they had access, were extremely small and cheerless.
Seven Females were confined in a room about twelve
feet square, where there was no furniture of any kind,
except one seat not large enough to accommodate more
than four persons, so that the rest were obliged to stand
or to sit on the brick floor. Some of the bed-rooms,
which had been before objected to, were dark, small, and
off"ensive. In one bed-room for females, the windows
had been all broken for three weeks, and in a sleeping-
room on the ground-floor was a woman, a dirty Patient,
curled up in her bed, which was wet and filthy, and con-
sisted of chaff and some rags, and she herself was in a
wretched condition. This House requires very great
improvement, to render it fit for the reception of Insane
Persons.

On the third visit of the Commissioners to the Asy-
lum at West Mailing, in Kent, on the 2nd of Septem-
ber, 1843, they were much astonished at discovering six
sleeping-places for Males in an outhouse, at the upper
end of the Male Paupers' yard. These places had not
been laid down in the plan of the House, and they had
never been shown either to the Visiting Justices, or to
the Metropolitan Commissioners, who had previously
visited the Asylum. They were wooden closets, six
feet long, six feet high, and three feet two inches
wide ; three being on each side of a passage, which
was between two and three feet wide. These places
had a raised floor, upon which the bedding was placed.
They were all extremely close, but the two centre ones
had no means of ventilation. They had been regularly

used, and were occupied by five Males ou the night before
they were discovered, and were made up for use when
first seen. They were, of course, quite unfit for sleep-
ing-places.*

— Having thus detailed the particulars of some of the Endeavours of

Commissioners

more flagrant abuses which have come under our obser- to remove
vation, we think it right to state to your Lordship that ^"^^^^ '
we have made various endeavours to procure their correc-
tion and removal. We have before stated what steps
were taken with respect to the Asylum at Haverfordwest, ^t Haverford-
As regards the Hospital of St. Peter's, at Bristol, we '^^f' ^^
received a communication, through Secretary Sir James
Graham from the Visiting Justices, immediately after our
first visit to it. In consequence of that communication,
we made a second visit to the Hospital, and upon a pro-
posal being made by the Magistrates of Bristol to enlarge
the present premises for the purpose of an Asylum, we
reported that, in our judgment, such a measure was
highly inexpedient.

Although a new County Lunatic Asylum was in pro- at Plympton ;
gress for the County of Devon, we felt that the condition
of the Paupers at Plympton called for some prompt
interposition, and we therefore addressed a letter to the
Chairman of the Quarter Sessions for the County of
Devon, on the 10th of August, 1843, after our second
visit, calling bis attention to the state of the House.
No answer had been received to this letter at the period
of our third visit, on the 2nd of October, 1843, when
the House was found in even a worse state than at the
second visit. Subsequently to our third visit, a letter
upon the subject was addressed by Lord Ashley, as
Chairman of this Board, to the Earl of Devon, who
thereupon took immediate steps with a view to remedy
the abuses complained of.

* These closets have since been pulled down and the building
shut up.

at West Auck-
land and
Wreckentou ;

at Derby ; The Paupers who were confined in the Licensed

House at Derby having been nearly all sent thither
by the Magistrates of the County, we addressed a let-
ter to the Chairman of the Quarter Sessions at Derby,
on the 10th of November, 1842, bringing the state of
the Paupers in that House under his notice. We received
an acknowledgment of the receipt of our letter on the
1st of March, 1843, but no further communication.
We wrote at the same time to the Magistrates of
the Borough, and received an immediate answer. The
Paupers, however, on our third visit to this House,
were found in the condition which we have above
described.

A letter was written to the Chairman of the Quarter
Sessions of the County of Durham, on the 15th of Feb-
ruary, 1843, accompanied with extracts from our Reports,
and we submitted to the Magistrates whether it would be
expedient to renew the Licenses of the Houses at West
Auckland and W^reckenton, without requiring effec-
tual alterations to be made in them, and security
for their better management in future. No answer
has been received to this letter. The House at
Wreckenton is considerably improved ; but that at
West Auckland remained nearly in the state which
we have above described, when visited, on the 19th of
April, 1844.

The Commissioners who first visited the Licensed
Houses at Lainston, Nursling, and Hilsea, in the County
of Hants, in October, 1842, called the attention of the
Visiting Justices to the urgent want of a Public Lunatic
Asylum for the Paupers of the County. The Justices
at Lainston; ^}xo have visited the House at Lainston since our first
visit, have, in the Visitor's Book, condemned in unqua-
lified terms the management of that large Asylum.
Nevertheless, the Commissioners who visited this place
in April, 1844, found no material improvement, and

could only earnestly repeat their call upon the Magis-
trates of the County of Hants to provide a proper recep-
tacle for their neglected Paupers.

In reference to the Licensed House at Box, near at Box ;
Bath, in the County of Wilts, we have repeatedly pointed
out to the Visiting Justices the very reprehensible state
of its yards, and the harsh and cruel system of restraint
which is there practised. The Visiting Justices con-
curred in our views, but the same defects as before were
in existence in April, 1844. We have called atten-
tion to the unfitness of the Licensed House at
Bailbrook, near Bath, in the County of Somerset, in at Bailbiook ;
its present state, for the care of Pauper Lunatics ; and we
have made similar remarks as to the Licensed House at
Duddeston, in the County of Warwick. We have also, at Duddeston ;
in various other instances, made such remarks, in the
Visitor's Books at the different Licensed Houses, as at other houses.
seemed to us calculated to excite the attention of the
Magistrates, to the condition of Houses requiring
alterations and improvements.
— By the Act 2 & 3 Will. IV. c. 107, it is directed that visitation of

three Justices, together with a medical attendant, shall Asylums m

' " Borough towns.

be appointed, at the General Quarter Sessions, to visit
all licensed Lunatic Asylums throughout England and
Wales, (except those in the Metropolitan district), three
times in every year. This power, or duty, so far as
respects the visitation of certain Asylums situate within
the limits of borough-towns, is now, by virtue of the
Municipal Corporations Act, exercised by the Magis-
trates of those boroughs.

The country is much indebted to the County and Services ren-
Borough Magistrates for their services, under these acts, ^^^ Borou T'^'
in all cases where their visitations have been carefully Magistrates.
and regularly made ; and we are desirous of bearing
testimony to the solicitude which they have, in many
instances, evinced to perform a very painful duty.

It is not our intention to enter into any minute
f2

Irregularity in examination of these visits, witli a view of testing their
Stes.^^ ^^^''" efficiency, in particular districts ; but we feel bound to
state certain facts which have come under our notice,
and to offer a few remarks, in order to bring the subject
of these provincial visits fairly under your Lordship's
consideration ; the value of which must depend upon
their frequency, upon their being made without notice,
and at uncertain intervals ; upon the minuteness of the
investigations that take place ; and, above all, upon the
firmness with which the visitors enforce the provisions
of the Acts of Parliament.
Oiiltnn, near The Licensed House at Oulton, near Stone, in

Stone, Stafford. Staffordshire, had not (in October 1843), been visited
by any magistrate for the space of two years and a
half. It is right to state, however, that the Medical
officer appointed to attend the magistrates had himself
visited this Asylum frequently during that period. The
Shillingthorpe, Asylum of ShiUiugthorpe, in the county of Lincoln,
mcoln. (which, however, is in excellent order, and so far

excuses the neglect of its visitors), is inspected by the
Magistrates once a year only, instead of three times a
Great Winston, year. — After our visit to Great Wigston Asylum, near
Leicestershire. Leicester, (in October 1843) we found that the magis-
trates had visited it only once during the preceding
Visits to twelve months. On visiting Heigham Hall Asylum, in

Heigham Hall, ^^^ couuty of Norfolk, (in August, 1843,) we found

Norfolk, com- -^ ^ & ' '^

paratively use- that the Magistrates visited the place regularly, but that
their inspection was rendered comparatively useless,
by their always sending beforehand for the visitors'
book, which gave the proprietors notice of their intended
visits. The visitations of Magistrates to the Asylum at
West Auckland have been already adverted to.

M^strates' Having felt it our duty thus plainly to express our

visits, m many opinion of the neglect, in some few instances, of the Visit-

mstances, regu- _ o ? :>

lar, and made ing Magistrates, we have the satisfaction of stating that,

in many instances, the visits of the Magistrates have

been regular, and that their inspection of the Asylums,

and their investigation as to the comforts and general
treatment of the lunatics, have been made with much
care; with evident solicitude to perform the duties
imposed upon them ; and with that benefit to the patients
which must necessarily arise from gentlemen of station
and local influence giving up their time and attention
to this subject.

It has however rarely happened that all the points Magistrates
to which we have thought it our duty to direct our Jo'alHbir'^^
inquiries, have entered into the consideration of thfe county points to -which
Magistrates. They appear, generally, to have limited ^i^ect their
their attention to the number, cleanliness, and bodily inquiries.
condition of the patients confined, and to the ventila-
tion and general fitness of the wards appropriated to
their use. And these, without doubt, are subjects of
great importance to the comforts, and in some degree
to the recovery, of persons afflicted with insanity.
Nevertheless, there are other subjects equally deserv- Points usually
ing of inquiry, to which we do not, generally speaking, °^^ ^'^^^ '
observe that the attention of the visiting justices has
extended. The first and most material of these
is the state of mind of the lunatic, in reference to
his fitness for liberation. Secondly, the nature and
ejBect of the employments provided for the patients,
with a view of diverting their disease. Thirdly, the
character of the medical reports, as indicative of the
care and intelligence bestowed upon the mental condi-
tion of the patients, by the medical officer; and,
fourthly, the food (both as to quality and quantity)
afforded to the pauper patients, the rates of payment
made for them, and the attention bestowed on them by
their parish officers.

In the more careful reports of the Magistrates, some of Remarks on
these subjects are occasionally adverted to, but in others repOTts.
both these and other points remain unnoticed. In a great
proportion of cases, the reports are couched in general
terms, expressive of the satisfaction of the Visitors at the
condition of the Asylum, without indicating any particu-

laf matter as deserving of notice. This species of report,
although it may be less objectionable in cases where
Asylums are appropriated exclusively to the reception of
private patients of the wealthier classes; yet in esta-
blishments which receive paupers and persons but little
above the rank of paupers, we have ourselves almost
always remarked some defect, or have suggested some
obvious improvement, in reference to the condition of the
place or of the patients ; and upon these occasions, we
have thought it right to make ri special statement to that
effect, in our entry, in the visitor's book, with a view
to future amendment ; and we have the satisfaction of
adding that these suggestions have, in many instances,
met with attention from the Visiting Magistrates. Not-
withstanding the influence, however, of these gentlemen,
and notwithstanding such improvements as those to which
we have alluded and many others, it must, we think,
be apparent from the state of the Asylums and Licensed
Houses at Haverfordwest, St. Peter's, West Auckland,
Wreckenton, Plympton, Derby, Lainston, Nursling,
Loddon, Aspall Hall, High Beach, Calne, Box, Bail-
brook, and others, that the visits of Magistrates have
not had the effect of correcting the irregularities and
the abuses existing in many of these Establishments, or
in putting an end, in some few instances, to cruelties of
a very flagrant character. Much, indeed, remains to
be done, in order to render many of the existing Asylums
proper and sufiicient receptacles for the Insane.
Additional Amongst other means of insuring good conduct in

cau ion neces- ^j^^ manaeement of Asylums, it has occurred to us that

sary in granting ° •< '

Licenses. some additional caution might be observed in the grant of

Licenses. Your Lordship is aware that Licenses in the

Metropolitan district are granted by us, and we are

careful that the Reports of the different Houses should

be brought under the consideration of the Board, before

Commissioners' each renewal. We cannot, therefore, finish our remarks

granting' upon the performance of the duties assigned by law to

Licenses recom- the county Magistrates, without recommending that they

should follow the same course in renewing the Licenses mended to Ma-
of the provincial Houses. We are of opinion that the ^'^ '^ ^^
proprietor of a Lunatic Asylum should always attend at
the Quarter Sessions when an original or renewed License
is applied for, with a view of answering such questions
as may be put to him ; and that the reports of the Visit-
ing Magistrates, and of the members of this Board, rela-
tive to the state of his House, should be then read. We
could further suggest, that in the advertisements usually
inserted in the county papers, announcing the business pro-
posed to be done at each sessions, special notice should be
entered of the intention of parties to apply for Licenses.
This is already done in Hertfordshire, and we believe in
a few other counties.* It is also essential, previously to

* On our first visit to the Retreat near York, we were accompanied
by Mr. Tuke, a gentleman well acquainted with the management of
most of the principal Lunatic Asylums, and who has for many years
made the treatment of Lunacy the subject of his especial observation,
and he called our attention to the necessity of a more frequent and
vigorous supervision of all Asylums. As he has already expressed his
sentiments on this subject, in a publication relating to Hospitals for
the Insane, we have thought it right to lay them before your Lordship.

" The appointment of visitors at the Quarter Sessions, to these
places, may afford a little check against abuse, and some facility for the
investigation of complaints ; but I do not hesitate to say, that it is a
most imperfect and unsatisfactory system of visitation, and so I know
it is felt and acknowledged to be by some who act under the appoint-
ment, A physician is appointed at the Sessions in conjunction with
three magistrates, to visit the private houses four [three] times in the
year. The magistrates will, of course, be much influenced in their
judgment by theii' medical companion, and thus he is often called upon
to judge the conduct of his professional neighbours, who may be either
his rivals or his particular fiiends. It is no imputation on the honour
of any man to say, that it is not for the public good that he should be
placed in such a position." — " We shall not, I apprehend, secure
efficient visitation, until we have an appointment of a number of com-
petent persons to visit, under the authority of Government, all the
places of whatever description, private or public, chartered or unchar-
tered, in which the insane are confined ; to compare the degrees of
human misery in these abodes, — to ascertain how it may he most
effectually provided for and alleviated, — to collect information under
uniform heads from Jail these institutions, — and to report annually to
the public the results of their observations and inquiries." — Intro-
duction to " Jacobi's Treatise on Hosipitals for the Insane.''

granting a License, to ascertain the fitness and security

of the premises.

Escapes from We have made inquiries upon the subject of escapes

Houses. ffom Licensed Houses, returns of which are require4. to

be made to our Board, and have not found in general

much cause of complaint upon this head. Some cases,

however, have occurred which call for animadversion,

and some matters relating to the safe custody of certain

classes of Insane Persons, demand notice at our hands.

Penaltyimposed The Act 9 Geo. IV. c. 40, has imposed a penalty

c, 40, on offi- Upon Officers and Servants of County Asylums who

cers, &c. of permit escapes through neglect or connivance. There

lums permitting is no similar provision with respect to the Servants of

on officers &c'. Licensed Houses, although it would seem that the safety

of Licensed of the Insane, and of the Public, and also of the Pro-
Houaes.

prietors of Licensed Houses, equally calls for legislative

protection. In the course of last summer, a Servant at

a Licensed House assisted a Lady, who was a Patient^

Dang;er of per- to escape. Escapes are not only to be guarded against
mitting escapes. r , i i , r • • •,

on account ot the hazard to others ol permittmg danger-
ous Lunatics to be at large, but also for the excitement
which they are apt to cause to the Insane themselves.
Case of Epilep- An Epileptic Lunatic who escaped from Mr. Kent's
GatesheadVll ^^y'^'^'^' ^t Gateshead Fell, near Newcastle, in Decem-
ber, 1842, was, at the time of his escape, employed with
a number of other Patients upon the Proprietor's farm.
He was immediately pursued, but was not retaken.
Application was made by the Proprietor to the police,
but the wife of the Lunatic interceded, and he was not
sent back to the Asylum. He escaped on the Saturday
afternoon, and on the Monday night after his escape
he murdered his wife and daughter, in a violent
paroxysm of epileptic mania, in a most savage and
horrid manner.

This wretched man is nowa furious criminal maniac in
the Licensed House from which he escaped, although
he was so far recovered as to be on the point of being

discharged. When he had escaped, he became so ap«
prehensive of being retaken, that he did not dare to go
to his own house, and it was only upon the intercession
of his wife with the authorities that he was permitted
to remain at large.

At a private Asylum at Dunnington, near York, Escapes at
there were when we visited it three dangerous Patients, ^^g^j, York •*
one of whom had threatened the life of a brother,
another the life of his wife, and a third the lives
of his wife and child. All these three individuals
had escaped at different times from the Asylum^
Another Patient, an old woman, had also escaped and
had not been since heard of. It was surmised that she
might have met with some accident. In this Asylum,
there was only one insufficient yard both for the Males
and Females, and the House was unfit for the safe cus-
tody of the Patients without locking them up in their
day rooms.

At Sandfield, near Lichfield, a Patient had escaped, at Sandfield

and at Plympton, a criminal Patient had escaped, for the "^^•' Lichfield,
•' ^ \ _ -^ and at Plymp-

third time, and neither of them had since been heard of. ton ;

At Nunkeeling, in Yorkshire, a most dangerous at Nunkeelings
Patient had escaped three times. We found him in con- '° Yorkshire.
finement after his third escape. His legs were confined
by leg-locks ; one arm was chained to his legs, and
both his arms were fastened behind him. He had twice
nearly succeeded in killing his keepers,and once in setting
fire to the Asylum. Both the restraint employed, and
the extremely small yard in which this man was confined
were calculated to injure his health. At a Licensed
House in Yorkshire, we found two Male Patients confined
in strait-jackets. We thought the restraint impro-
per, and after some remonstrance with the keeper,
they were removed. The restraint used for one of these
Patients was, it was said, to prevent his escaping. He
promised us not to attempt to escape for a limited time.
He kept his word ; but after the lapse of the period which

Improper re-
straint.

Escapes at
Han well.

Consequences
of escapes.

Visitation of
Paupers by
Parish Officers.

was fixedj lie made his escape. This Patient had an
attendant entirely for himself. The improper restraint
which we have met with in the Houses at Lainston,
Plympton, and elsewhere, has been defended on the
ground of the apprehension of escape. The use, however,
of restraint is not a proper remedy against escape, except,
perhaps, in cases of very violent or dangerous Patients.
We were informed that the escapes from Hanwell had
been numerous, and we have since been furnished with
an account of them. From the years 1831 to 1843,
both inclusive, it appears that the escapes have been in
all 245. These do not include those cases in which a
Patient has been almost immediately retaken by the
servants of the Asylum. The total cost of retaking these
persons has been 7 SI. 14s. 9d. The greatest number of
escapes that took place in any one year from 1831 to
1837, was seventeen ; and from 1837 to 1843, both
inclusive, the highest number in any year was thirty-
eight. We are not aware, however, that any serious
mischief arose from these escapes.

The above remarks are not made with the view of
offering any suggestions, but merely of calling attention
to the" fact that very calamitous consequences may result
from escapes, and that therefore it is important to take
every possible precaution to prevent them ; not by the
use of restraint, but by vigilance and care. It is desir-
able, also, to ascertain, before a License is granted to the
Proprietor of a House, that there are proper means
to keep the inmates in safe custody, without resorting
to such improper restraint, and confinement in gloomy
places, as we found practised at West Auckland, Nun-
keeling, and elsewhere, and which are calculated to
destroy the bodily health of the patients.

In regard to the visits of the officers of parishes and
unions, to their paupers, vre observe that the Medical
officer in each case generally visits them regularly, and
at no very distant intervals ; excepting only when the

paupers are sent from distant counties, wlien there

appears, for the most part, neglect in this respect.

We are of opinion that no pauper should be sent to Paupers should

any Asylum which is at a great distance from the distant Asy-

parish or union to which he belongs ; in order that there ^"™®'

may be no excuse for not "visiting him regularly, and

no motive (such as the saving of expense) to prevent or

delay his removal home, when reported convalescent.

We find, upon inquiry at various provincial Asy- Visits of fiieads
lums, that the friends of pauper patients are allowed unties,
to visit them on certain days in the week, or on all
days of the week, excepting Sundays. It is worth con-
sideration, whether the Asylums should not be open,
during certain hours, on Sundays also, to the visits of
the friends of poor lunatics, whenever they are in such
a state of health as to render such visits not injurious.
Those friends, for the most part, belong to the labour-
ing classes of the community, and if they are to be
precluded from visiting the patients on the only day on
which they themselves are unoccupied, the probability
is that the pauper lunatic, whilst he remains in an
Asylum, may be altogether denied the comfort of a
visit from his friends. In all cases where it may be
advisable to refuse the admission of the friends, the
reasons for such refusal should be stated in writing by
the Medical officer.

In regard to the visits made to private patients, Visits to Private
these appear, in general, to be made with sufficient
frequency, so long as any probability of cure exists.
When the patients become incurable, these visits, in
many cases, become more rare.

It is customary, in all respectable Licensed Houses, to
allow any near relation of the patient to visit him, at
proper times, unless the state of his health should render
such visits unadvisable. There are, however, occasions
when the proprietor of the Asylum considers himself
bound to submit, in this respect, to the directions of the

person under whose authority the patient is first con-
fined. In one instance, the trustee of an insane lady,
confined in the Asylum at Laverstock near Salisbury,
was for a long time refused admittance to the patient,
by the directions of the person who had authorised her
confinement ; and the Proprietor of the Asylum, in
answer to our question on that head, said that he con-
sidered himself bound to obey those directions, whether
the visit of the Trustee to his Patient would be likely to
benefit her health or not. In another case, where a
male patient was confined at the Asylum at Southall,
in Middlesex, on the authority of his son, his daughter
was, by the son's order, arbitrarily prevented from visit-
ing him. There did not appear to be any reason for
the exclusion. The power thus vested in any person to
prevent the access of a child, or near relation, is obvi-
ously liable to great abuse.

Our attention has been drawn to the position in
which Lunatics, who have not been the subjects of Com-
mission, are placed with respect to their property, whilst
Liberality usual they are confined in Asylums. Many persons are most
liberal to their unfortunate friends whom it has become
necessary to put under the restraint of an Asylum, and
we have seen many instances of great liberality on the
part of the Proprietors of Licensed Houses, in maintain-
ing their inmates, for many years, as Private Patients,
at considerable expense, with little, and in some cases
no prospect of reimbursement. Some cases, however,
have been stated to us where the party is believed to
be entitled to a considerable income, and a small por-
tion of it only is applied to his maintenance ; others,
where the whole property has been applied by Trustees,
or others, to their own purposes, and the Lunatic has
thus been left entirely destitute. Other cases again
have occurred, in which the patient has been allowed,
whilst in the Asylum, or during a temporary visit to his
friends, to execute instruments materially affecting his

Position of
Lunatics with
respect to their
property.

towards Luna^
tics.

Cases of Pecu
lation.

property. We have not had the means of testing the
accuracy of these statements.

Our attention has been called, in the course of our
visitations, to the following, among other cases, upon
the correctness of which we have every reason to rely.

W , an Imbecile, was for many years confined at Case in Dr.

Dr. Warburton s House, at Bethnal Green. Upon his Ho^'g^^"''"''''

father's death, he was allowed to go out of the Asylum

for some hours : he went to his sister's house, and,

whilst there, signed some deeds, the nature of which he

did not understand, but was told that he was to share in

his father's property, whose heir he was. He is now a

Pauper, in the Asylum for the County of Surrey.

A Gentleman, now in Dr. Finch's House at Laver- in Dr. Finch's
stock, had formerly a large property. For many years ""^^ '
Dr. Finch has received nothing, and there is a very
large sum owing to him for his maintenance, and he is
still furnished gratuitously with the comforts and ac-
commodations of a private Patient. '

Mr. H., an Idiot in Mr. Jackson's House at Turnham in Mr. Jack-
Green, had £400 a year in the funds, left to him by " '
his father. The executors paid the dividend, for some
years, but ultimately absconded, having misappropriated
the funds, and the poor Idiot is now destitute. Miss B.,
who was under confinement for several years at Dr.
Tukes' House, had £2000 left to her by her father.
The executor employed this sum in his business, and
the whole was lost.

There are two brothers. Paupers in Dr. Warburton's in Dr. War-

TT ^1 1 1 r 1 • r ^ • 1 burton's House:

Jtlouse, the elder or whom, we are intormed, is supposed

to have become entitled to property worth £20,000.

One of them is generally employed as a tailor, but he is

so lost that he does not know where he comes from, and

the other brother is in a worse state.

We would also recall your Lordship's recollection to before the Lord

a case, which not long since came before your Lordship '-'haiicellor.

in consequence of a commission of lunacy, namely, that

Provision for
protection of
Lunatics' pro-
perty wliere no
Commission
issued recom-
mended.

of R, P. H., who was very properly placed by his bro-
ther in an Asylum, and which brother immediately
took possession of all his property, producing an income
of upwards of 400?. a year, and remained in possession
of it until his death in 1840, applying only a very
trifling part of such income to the Lunatic's support
and then died insolvent.*

- We beg- to submit for your Lordship's consideration,
whether some provision might not be made for the
protection of the property of Lunatics, who shall have
been in confinement for more than a fixed period, and
where no Commission has been applied for. It has
been suggested that where a Lunatic has been confined
for six or twelve months, a verified statement might be
required to be made by the persons upon whose order he
is detained, as to the amount and nature of his property ;
and some security might be required for its dueadminis-.
tration, or an ofiicial Trustee be appointed for that
purpose.
It has also been suggested, that in cases where the

* The particulars of this case are as follows : — In July, 1805
R. P. H. was placed hy his brother in the Asylum of Dr. Burman
at Henley in Arden. He was at the time entitled to freehold pro-
perty in Northamptonshire, and Somersetshire, and Gloucestershire,
now producing an income of more than 460/. a year ; and was also the
owner of the advowson of a living worth 300/. a year and upwards.
He also held a commission in the army. The brother sold the com-
mission, and cut timber, and received the proceeds of each, and the
rents of the freehold property from 1805 to October, 1840, when he
died. He was also in 1807, being a clergyman, instituted to the
living, under a paper to which he procurecf the signature of his brother,
when in the Asylum.

The brother died in 1840, perfectly insolvent, and having only
applied about 120^ a year for the maintenance of the Lunatic, and
even that sum was often much in arrear, and for some period before his
death was not paid at all. The brother had also received money in
respect of a fee-farm rent of the Lunatic, which he professed to sell,
and also in respect of a further mortgage, which he professed to make
on the Lunatic's property. On the death of the brother a commission
was taken out in 1841 by Messrs. Burman, and the jury found R,
P. H. to have been of unsound mind from the 2nd of July, 1805, and
the property has since been protected.

malady is likely to be of short duration, or the property
of the Patient is small, a competent portion of the
income might, during a limited period only, be applied
for his maintenance, under the sanction of one of the
Commissioners in Lunacy,* acting with the consent of
the nearest relatives, and of the former having the con-
trol of the fund : and that the written instructions of
the Commissioners to that effect, issued under such
circumstances, should be a sufficient warrant for such
application.

We are aware that these are matters of considerable
delicacy ; and that they do not, at least directly, fall
within our proper province. At the same time, as they
have not unfrequently come under our observation in-
cidentally, and appear in themselves to deserve serious
consideration, we hope to be excused for having thus
ventured to call your Lordship's attention to the subject.

II.

CONDITION OF PAUPERS ON ADMISSION.

No subject to which our attention has been given, Evils resulting

is of deeper interest and importance than the inquiry ^•"^ "^^^^^ ^^
^ '■ . sending Pauper

directed to be made (5 & 6 Yic. c. 87, s. 11) "into Lunatics to
the condition as well mental as bodily of the pauper ^ ^
patients when first received into Asylums, and whether
this has been such as to prevent or impede the ultimate
recovery either mental or bodily of such patients." And
this subject is of the greater moment, inasmuch as
the evils resulting from the delay in sending pauper
lunatics to Asylums is, we fear, to some extent, appli-

* Appointed under ttie 5 and 6 Vict,, c. 84.

Pi-actice of
detaining Pau-
per Lunatics,
long after the
attack of
mental disease
iu Work-
houses. &c.

cable to the cases of private patients, in all classes of
society.

Although it appears that pauper lunatics, in some
few districts of England, are sent to Asylums soon after
the first attack of mental disease, we have found, that
the practice of detaining them for long periods subse--
quently, (either in Workhouses, or as boarders with
their friends, or elsewhere,) prevails to a very large extent
throughout the kingdom. In order to bring this subject
in a more distinct manner, before your lordship, and to
show the evils which result from it, we beg to call your
Appendix (C). lordship's attention to Appendix (C.) at the foot of
this report. This appendix contains the answers given
to our inquiries, by the Medical Superintendents and
Visiting Physicians of the different County Asylums
and Public Hospitals for lunatics, and by the proprietors
of a large number of licensed houses into which paupers
are admitted.

In the Asylums of Lincoln, Leicester, Nottingham,
and Northampton, the Superintendents and Visiting
Physicians of those institutions have expressed their
unanimous opinion, that pauper lunatics are sent there
at so late a period of their disease, as to impede or
prevent their ultimate recovery. Opinions, to nearly the
same effect, have been given by the medical superintend-
ents of every County Lunatic Asylum, with the excep-
tion of those of the Asylums for the counties of Bedford
and Stafford. It is right to remark that, in some in-
stances, there has been a reluctance to express any opinion
as to the bad and hopeless condition in which pauper
lunatics have been taken to Asylums, from a fear of
offending either parish officers or other persons.

At the Retreat, York, at the Asylums of Lincoln and
Northampton, and at the Asylum for the county of
Suffolk, tables are published, exhibiting the large pro-
portion of cures effected in cases where patients are
admitted within three months of their attacks, the less

proportion when admitted after three months, and the
almost hopelessness of cure when personsjare permitted
to remain in Workhouses or elsewhere, and are not sent
into proper Asylums until after the lapse of a year from
the period when they have been first subject to insanity.
The Asylums for the counties of Lancaster and Middlesex
and for the West Riding of the county of York have
published statements to the same effect. In the Dorset
County Asylum, out of tliirty-seven cases admitted in
the year 1842, only six were received within three
months after their first attack. Five of these six re-
covered, and were discharged within four months from
the time of their admission, and the sixth, a female,
aged seventy-five, was improving at the time of our
visit.

In the year 1842, the cures in St. Luke's Hospital Average of
averaged seventy, and in the year 1843, sixty-five, per Luke's.
cent., a fact which, even taking into account the circum-
stance of their receiving only recent cases, and such as
are supposed to be curable, is calculated to remove the
reluctance commonly felt to send the insane to Asylums,
and to exhibit the great importance of removing Luna-
tics as soon as possible after the first appearance of
disease, to institutions where proper medical treatment
can be obtained.

The reasons principally assigned for the insane poor Reasons as-
being sent so late to Lunatic Asylums, have been the ^'^"^ se°nt^so'
ignorance of overseers and guardians of the poor as to l^*^-
the importance of early medical treatment in cases of
insanity, and their reluctance to send paupers to Lunatic
Asylums, on account of the great additional expenses
incurred in those establishments beyond the ordinary
cost of maintenance in Workhouses or in lodgings. There
can be no doubt that both these causes have operated to
a great extent, in improperly detaining paupers from
Lunatic Asylums. There are, however, other circum-
stances, which, as we conceive, have still greater influence

Want of accom
modation for
insane poor.

in causing this serious evil. Even if there did exist en
the part of guardians and overseers of the poor a full
knowledge of the importance of early treatment, and the
most earnest desire to avail themselves of its advantages,
throughout almost the whole of England, and in the
whole of Wales, there is so great a want of accommoda-
tion for the reception of the insane poor, that they could
not carry their views into effect.

A mere summary of the total number of insane poor,
and of the total amount of accommodation provided for
them in the different public and private Asylums
throughout the kingdom, would not, by showing the
general insufficiency of Asylums for their reception,
expose all the inconveniences and evils which result
from the present system of managing pauper lunatics.
We shall submit, however, as accurately as is in our
power, the details of the numbers of insane poor, and
the extent of accommodation provided for them in
different counties ; for the purpose of explaining the
grounds upon which we have formed our opinion, as to
the causes which combine, with the reluctance and mis-
taken economy of parish authorities, to produce this
serious evil.
Appendix (D). "We have annexed, in Appendix (D), a detailed account
of the numbers of pauper lunatics, and of the accom-
modation for them : — First, in those counties which
have Lunatic Asylums erected exclusively for paupers,
and also in those counties which have Lunatic Asy-
lums for paupers erected in union with subscription
Asylums; — Secondly, a statement of the numbers of
pauper lunatics in every county, and the entire accommo-
dation whether public or private for them ; — And thirdly,
a list of those counties and districts which have no
Lunatic Asylums of any description, either public or
private, and the numbers of pauper lunatics contained
in them.

From the statements in Appendix (D), it is apparent,

first, that in those counties in which Lunatic Asylumshave Difficulty <yf

. ji'ii • obtaining ad-

been erected exclusively for paupers, and also m those m n,ission for

which Lunatic Asylums for paupers have been erected Pauper Luna-
•' -^ ^ tics in recent

in union with subscription Asylums, there are large cases.

numbers of insane poor for whom there is no room, owing
to nearly all the Asylums being full of patients. Even in
those counties, therefore, where there are public Asylums,
there frequently exists difficulty in obtaining admission
for recent cases. Secondly, it will be seen that in those
counties where there are public and private, and in some
instances, only private Asylums receiving paupers, there
is a striking deficiency of accommodation. Thirdly, it is
apparent that in eleven counties in England and in all
the counties in Wales, with two exceptions, there are
no public or private Asylums of any kind, and conse-
quently the insane poor must ba sent to distances from
their own homes, at a greater expense than if there were
Asylums near at liand. This circumstance is of itself
calculated to increase the unwillingness of overseers and
parish officers to send patients, in proper time, to
these Establishments.

As regards the state of pauper Lunatics in counties ^'^^^ "^ Pauper

. Lunatics wliere

havmg County Asylums, we must remark that the there are Coun-
Asylums for the counties of Chester, Cornwall, Dorset, ^^ Asylums.
Lancaster, Middlesex, Stafford, Suffi^lk, and for the
West Riding of York, have all been reported to our
board as having been found in a very crowded state.
In the Workhouse at St. Austle in Cornwall, the Visit-
ing Commissioners found a woman in a state of raving
mania. The master of the Workhouse had applied to
the County Asylum at Bodmin, for the admission of this
person, but it was so crowded, that her admission had
been refused, and it was only upon urgent application
that she was subsequently received. In this County,
there were 153 lunatics in Workhouses and other places
out of the County Asylum. At the Asylum, at Forston,
for the County of Dorset, where the Superintendent has
G 2

84'

for a long time exerted himself to expose and remedy
the evils resulting from cases being kept back from the
Asylum, the Visiting Commissioners met with another
instance during their visit, in which the admission of a
patient was delayed for want of room. In this County,
there were 114 pauper lunatics in "Workhouses and
other places out of the County Asylum.
Asylums have Jn addition to the above facts, it must be observed, as

been necessarily . /-< •

enlarged. a remarkable circumstance, with respect to Counties

having public pauper Lunatic Asylums, that it has
been found necessary to enlarge almost every Asylum of
that sort that has hitherto been erected. The Asylums
for the counties of Bedford, Cornwall, Gloucester, Kent,
Lancaster, Leicester, Middlesex and Nottingham, and for
the West Riding of York, have all been enlarged, and
some of them several times. The Leicester Asylum was
opened in 1837, and had additional accommodation made
for fifty paupers in 1841. The Bedford Asylum has
been twice enlarged. We were informed that the second
additions were made with the view of receiving pauper
lunatics from other counties, and thus diminishing the
cost of maintaining the pauper lunatics of the county of
Bedford. This circumstance may, in some degree, ex-
plain the reason, why in the county of Bedford, paupers
have been sent in good time to the county Asylum. In
the Hanwell Asylum, and also in the Surrey Asylum,
(opened only in 1841,) and in some of the other Asylums,
the basement stories have, contrary to the original
intention, been brought into occupation for patients.

Increasing num- We have mentioned these instances, as we are

bei- of incura- a,nxious to draw your Lordship's attention to the
ble cases. •' ^

important fact that, however sufficient for the pauper

lunatics of a county any Lunatic Asylum may have

! been at the period of its original erection, it has

subsequently, and in many instances in a very short

period, become insufficient, and is at the present

time crowded with a large and increasing number of

incurable cases. And that we do not assert this on
slight grounds, the following Table, exhibiting the num-
ber of inmates in every county Asylum erected exclu-
sively for paupers, and also in every county Asylvim for
paupers erected in combination with subscription Asy-
lums, will make abundantly evident.

County Asylums.

County and Subscription Asylums.

Bedford . .
Chester .
Dorset . •
Kent . . .
Lancaster .
Middlesex
Norfolk . .
Suffolk . .
Surrey . .
YorkVV.R.

Cura-
ble.

Incur -
able.

Total.

Cornwall .
Glos'ter ,
Leicester .
Nottingham
Stafford . .

Cura- Incur-
ble. 1 able.

Total.

27
48
14
22
65
58
108
27
20
48

112
116
139
227
546
917
56
179
362
384

139
164
153
249
601
975
164
206
382
432

13
59
63
37

120

198

197

133
257
131
125
245

Your Lordship is aware that the Legislature has not
only given to Justices of the Peace the management of
County Asylums, but also, (as a necessary adjunct, to
carry into effect the objects for which they are erected,)
the disposal of all the Pauper Lunatics in their respective
counties. By the act of 9 Geo. 4, c. 40, sec. 36, the Jus-
tices " acting for any county in England " are required to
issue their warrants to Overseers to return lists of all
insane persons chargeable to their respective parishes,
specifying the " name, sex, and age of each insane per-
son, and whether such insane person be dangerous, or
otherwise, and for what length of time they have been
disordered in their senses, and where confined, or how
otherwise disposed of." These lists are to be verified
on " oath, with a certificate as to the state and condi-
tion of every insane person, from a physician, surgeon,
or apothecary," and are to be transmitted to the Clerk
of the Peace, to be laid before the Justices at the next

Disposal of all
Pauper Luna-
tics entrusted
to Justices.

Return required
from overseers
by 9 Geo. IV.
c. 40, 8. 36.

K'o system
adopted by
County Magis-
trates for early
admission of
Pauper Luna-
tics into Asy-
lums.

Provisions of
the law have
not been carried
into effect.

Establishment
and subsequent
increase of
Asylum at
Hauwell.

General Quarter Sessions. By section 37, any Overseer*
neglecting to give information of any insane person
chargeable to his parish, is subjected to a penalty : and
by section 38, any Justice is empowered to require
any insane pauper to be brought before tvpo Justices,
who may cause such pauper to be conveyed to the
County Asylum, or, if none, to some public Hospital or
Licensed House.

The Visiting Justices of County Lunatic Asylums
have usually taken an interest in the internal manage-
ment of their Asylums, and have framed rules for their
government. We have not, however, met with any
instance in which the County Magistrates have availed
themselves of the information afforded them by the
above-mentioned Acts, or have established any system
for securing the early admission of pauper lunatics into
the County Asylum. These lunatics are amongst the:
persons for whose benefit the establishment has been
erected at a great expense to the county.

Whether County Magistrates have not been aware of
the serious evil that was rapidly growing up throughout
the kingdom, or have been reluctant to rely upon their
own judgment, or unable to obtain satisfactory medical
advice for their guidance, it is manifest that the pro-
visions of the law have not been carried into effect,
and that the public and the poor have been equally
deprived of the benefits of these salutary enactments.
The management of the pauper Lunatics of the county
of Middlesex, and their present condition, will illustrate
our remarks.

The County Asylum at Hanwell was originally erected
for 300 patients, and was opened in the year 1831. In
1837 additional wings were built for a further number
of 360. In 1832, the building, which had been erected

* The duties imposed by this Act on Overseers, ai-c now transferred
to the Guardians, as to Parishes which are in Unions.

for 300, was made to accommodate 500 patients, and
the Asylum, enlarged so as to contain 650 patients, lias
been made to hold 1000 beds. This has been effected
by appropriating to the use of the patients, rooms
intended for a kitchen, and also offices and places on
the basement floor, under the level of the adjoining
ground, not intended to be inhabited. Thus there has
been introduced a number greater by 350 than the
Asylum was constructed to hold ; and at the time of
our visit, in 1844, there were 984 patients in the house.
There were also in the county of Middlesex, as
appears by the return made to the Quarter Sessions in Number of

Paupers for

1 843, 429 pauper Lunatics for whom there was no whom there
room in the County Asylum. In the Lunatic wards of j^^CouDt*° A
the Marylebone Workhouse there were admitted in the ^u™ in 1843.
years 1842 and 1843, 190 paupers considered as insane.
Some few of these, however, were stated to be only
under temporary excitement. The overseers of this
parish could obtain admission into the Hanwell Asylum
for only twenty-seven of these 190 cases, and they
therefore ceased to apply for admissions, and left a
notice at the Asylum, requesting to be informed when
any vacancy might occur. They also requested the Refusal of Jus-
Committee of Visiting Justices to permit them to incurable Pa-
exchange some of their old incurable patients at the ^^^^^^ ^° ^^

° exchanged for

Asylum for recent curable cases from the "VYorkhouse. curable ones.

This the Justices refused to do, on the ground that

the diet was better at Hanwell than at the "Workhouse,

and that the patients enjoyed more comfort at the

County Asylum.

The Rule for the admission of patients in Han- Rule for ad-
. . 1 1 J J.' i niission of

well IS, that every parish is entitled to send one patient Patients at

for every 7000Z. of its rated rental, and every parish not Hanwell.
rated so high is entitled to send one patient. The
Magistrates take no steps to ascertain the nature of the
cases previously to admission, with a view to the pre-
ference of recent cases. The Parish Officers frequently

Attempts of
Justices to com-
pel overseers
to send recent
cases.

The House
filled with old
and incurable
cases.

Visiting Magis-
trates have not
taken steps to
secuie admis-
sion of recent
cases.

The cure of
insanity the
main object of a
County Asy-
lum.

merely mention the number, •without even the names^
of the patients requiring admission. This was the
information given to us at the Asylum.

The first Committee of Visiting Justices gave notice,
in 1831, that they intended to take measures for com-
pelling the overseers to send to the County Asylum
" those of their patients whose cases admitted there
" should be the greatest probability of curing." In 1832,
they called the attention of the County Magistrates to the
fact of recent cases not having been sent to the Asylum,
and they declared the delay to be illegal; and they
have since repeatedly published Tables and Reports,
showing the great advantages to be derived from
cases of insanity being received at the Asylum in the
earliest stages of the complaint, and the great evils
resulting from an opposite course. The resident Phy-
sician called the notice of the Magistrates, in 1834, to
the " melancholy fact of the house being filled by old
and incurable cases," which he attributed "almost
entirely to the neglect of proper remedies in the early
stages of the disease;" and in 1836 he also stated
" that the additional room made for the patients
" during the year had been almost entirely filled up by
" old and incurable cases, only ten, said to be of recent
" date, having been admitted." The resident Physician
has, from time to time, called attention in his Reports
to the incurable state in which paupers have been
brought to the Asylum.

From the foregoing statement it will appear that
no steps have been taken by the Visiting Magistrates
of Middlesex, pursuant to their notice in 1831, to secure
the admission of recent cases, and that, in reference to
the populous parish of Marylebone, they refused to
exchange old incurable for recent and curable cases.
But the professed and indeed the main object of a
county Asylum is, or ought to be, the cure of insanity.
The patient who has had the benefit of a trial in the

Asylum where he has become incurable, should, we

submit, give way to the afflicted pauper who is in the

Workhouse or at home, and is probably curable, and

equally entitled to be received at the Asylum, where, by

prompt and proper treatment, he may be restored to

health and to his family, instead of being permitted to

become an incurable lunatic, a source of expense to

others, and of suffering to himself. A County Asylum

is erected for the benefit of the whole county, and is to

be considered not merely as a place of seclusion or safe

custody, but as a public Hospital for cure. A large

number of the patients now in Hanwell derive no Many patients

substantial advantage from the means of exercise and ^"J^^ uo bene=

° _ fit from the

employment furnished in that Asylum, and might be Asylum.
provided for in a separate Establishment ; thus making
room for patients who are susceptible of cure.

The result of the system, adopted by the Justices in Kesult of the
Middlesex, is, that the County Asylum is nearly filled 'y''^™'
with incurable Lunatics, and almost all the recent cases
are, practically, excluded from it. When we visited it
in March last, there were 984 patients, of whom only
30 were reported curable ; and there were 429 patients
belonging to the County out of the Asylum, and 40
applications for admission had been refused within less
than three months from the commencement of the
present year.

In 1831, there were 300 patients, for whom there was
no County Asylum whatever ; and in 1844, although
there is an Asylum holding 984 patients, there are 429
pauper Lunatics unprovided for, and who, if they wait
for the rota before they are admitted, will probably
have become incurable, and will be lunatic annuitants
upon the county or their parishes.

There is some difficulty in ascertaining the exact cost Cost of Esta-
of the Asylum at Hanwell • but we believe that at least ^'^^""^f* ^*

•' Hanwell.

160,000/. has been expended upon the land and buildings.
The maintenance of paupers in this Asylum in the year

An extension
of the establish-
meat likely to
increase the ac
cumulation of
incurable cases,
■without extend-
ing the re-
sources of cure.

Serious atten*
tion of the
Legislature
called to the
state of Middle-
sex with respect
to Pauper
Lunatics.

Condition of
County of Lan-
caster.

1843, cost their parishes 24,049/. l'2s. 6c/., which does not
include a sum of about 4000/. a year paid by the
county for the yearly cost of furniture, and the wages
of mechanics and labourers employed about the ordi-
nary repairs and work of the establishment. Not-
withstanding this annual expenditure of 28,000/., and
an outlay of 160,000/., there are stiU 429 Lunatics
unprovided for, to be maintained by their parishes.
We have stated ovir reasons for thinking that the
Hanwell Asylum ought not to be enlarged. The origi-
nal cost of Hanwell for 300 patients was 124,000/,
Supposing a similar outlay for the 429 patients, and the
cost of maintaining each of these persons to be the
same as that of a Lunatic in the present Asylum, the
annual charge on the parishes and county, for tlie Pauper
Lunatics (besides an additional outlay of 124,000/.,
making altogether 284,000/.) will be 36,000/. And,
should the magistrates enlarge their accommodations
and continue their present system of admission, they
will, apparently, but increase the accumulation of in-
curable cases, without extending the resources of cure.

We have called attention to the state of the County
of Middlesex, with respect to its Pauper Lunatics,
because, although the evils which exist there, prevail
to a very great extent in other counties, they have risen
up in the county of Middlesex with a rapidity which has
not been equalled elsewhere, and to a magnitude which
appears to us to require the serious attention of the
liCgislature.

The condition of the county of Lancaster shows that
the evils, which we have pointed out as existing in
Middlesex, are not confined to the last-mentioned county.
In 1816, the Lancaster Asylum was opened for 160
patients. It now contains 600 patients, and there are
more than 500 Pauper Lunatics in the county, for
whom it has no accommodation ; and the information
obtained at this Asylum isj that nearly all of them

have been brought from "Workhouses, where they have
been detained so long as to diminish the probability of
their recovery. The counties of Middlesex and Lan- Peculiar con-

0.1 1 1 rjL*i.i-'i_ J.X dition of Coun"

caster have a large class oi patients, which are not met ^jg^ ^f Middle-
with, in the same numbers, in other counties. The ^'^^ ^^"^ ^^^'

caster as re-

county of Middlesex had, in 1841, 108, in 1842, 116, gards Pauper
and 1843, 126, county Pauper Lunatics, or Lunatics "°^'''=*-
whose settlement had not been ascertained. The county
of Lancaster had, in 1842, 118 county Pauper
Lunatics.

The Asylum for the county of Surrey was opened in Establishment
June 1841, and the Visiting Physician went round to «f Asylum for

' a ./ county or our-

the different licensed Asylums in which the pauper rey.
Lunatics were distributed, and selected from them
299 cases, which were thereupon removed to the county
Asylum. At the period of our visit in 1843, there
were 385 cases, including those which had been removed
from Licensed Houses. All these 385 persons, with
the exception of only thirty-seven cases, had been
insane more than twelve months. There were
(according to the Poor Law returns for 1843,) 591
pauper Lunatics belonging to the county of Surrey ; and
the number in the Asylum, on the 1st January, 1844,
was 382, of whom 362 were reported incurable. We
inquired at this Asylum if any steps had been taken
by the Visiting Magistrates to secure recent cases being
sent there, but we were informed that no measures had
been adopted for that purpose, and we fear that the condi-
tion of the county of Surrey, with an excellent Asylum,
will soon, as regards the cure of its insane poor, be similar
to that of the county of Middlesex, unless patients be
sent to the Asylum in an earlier period of their disorder,
and some plan be devised for disposing of such of the
incurable cases as it may be necessary, in that event,
to remove.

These remarks lead us to another and most important
cause, which operates to fill Lunatic Asylums with incu-

Lunacy essen-
tially different
from other
maladies.

Patients beyond
reach of medical
skill should be
removed from
Asylums, insti-
tuted for cures.

Places of Re-
fuge should be
provided for
Incurable Luna-
tics.

Table patients, and to prevent the public from deriving any
considerable benefit from them as Hospitals for the cure
of Lunacy ; and this must continue to operate and neu*
tralise all other efforts for the benefit of the insane,
unless means are adopted to relieve the Asylums, from
time to time, from the pressure of incurable patients,
and to provide for such patients in some other Establish-
ment.

The disease of Lunacy, it should be observed, is
essentially different in its character from other mala-
dies. In a certain proportion of cases, the Patient
neither recovers nor dies, but remains an incurable
lunatic, requiring little medical skill in respect to
his mental disease, and frequently living many years.
A Patient in this state requires a place of refuge ; but
his disease being beyond the reach of medical skill, it
is quite evident that he should be removed from Asy-
lums instituted for the cure of insanity, in order to make
room for others whose cases have not yet become
hopeless. If some plan of this sort be not adopted, the
Asylums admitting Paupers will necessarily continue
full of Incurable Patients ; and those whose cases still
admit of cure, will be unable to obtain admission, until
they themselves become incurable ; and the skill and
labour of the physician will thus be wasted upon
improper objects.

Under all these circumstances, it seems absolutely
necessary that distinct places of refuge should be pro-
vided for Lunatic Patients who have become incurable.
The great expenses of a Lunatic Hospital are unneces-
sary for Incurable Patients : the medical staff, the num-
ber of attendants, the minute classification, and ^the
other requisites of a Hospital for the cure of disease,
are not required to the same extent. An establishment,
therefore, upon a much less expensive scale would be
sufficient.

In illustration of these remarks we call to your

Lordship's notice the rapidity with which the accu- Rapid accumu-
mulation of patients has taken place at the Asylum p'l"'^ '* •
for the County of Lancaster: — From the 25th June, Lancaster Asf-
1842, to the 24th June, 1843, 267 patients were ad-
mitted into this Asylum. The discharges during the
same period amounted to 103, and the deaths to 71,
and thus were added, in that year, 93 persons, whose
chance of recovery was diminished by the circumstance
of it not having been eflfected within the first twelve
months. A similar accumulation is taking place, Similar accu-

althouoh not to the same extent, in nearly all the ^"^at'o^iu

® •' other Asjlums.

county Asylums; so that a certain and progressive

increase of chronic or incurable cases is produced, in all

houses which have no outlet for them, a circumstance

which seems never to have been contemplated by those

who have the management of these large public Asylums,

and for which no relief or remedy has hitherto been

provided.

We are glad to remark that the Visiting Justices of Substitution of

the Asylums for the West Riding of the county of York, "'^"'"^^ ^°^ °^^ ,

•' _ ° J ^ cases permitted

and for the counties of Nottingham and Stafford, permit in certain
the substitution of recent for old cases.

The disposal of incurable patients, however, although Disposal of In-
a very serious and difficult question, is certainly of less ^^^^g ^
moment than the exclusion of curable cases from Lunatic
Hospitals, which have been erected at great public cost,
and are fitted up with every convenience for the pur-
pose of cure.

As far as we can learn, the admission of patients Admission of
appears, for the most part, to be either indiscriminate or ^'^^i*^°'^ "^"'^"

irsT' r •> cnmate or

matter of accidental arrangement, and has no reference accidental.
to the urgency of each case. In reference to the length
of time during which incurable Patients remain in
Asylums, and the great importance therefore of early
admissions, with the view of diminishing their numbers,
it may be observed, that those who recover generally
do so within the first year after their attack, and

at Hanwell.

that those who do not recover within the first two
years after tlieir attack, seldom regain the use of their
Table published reason. In reference to this subject, we may state that
ing Physician" *^^ Superintending Physician of the Hanwell Asylum
has published a Table, showing the length of time
during which each patient who was in that Asylum
in the year 1842 had been confined there. The dura-
tion of the confinement of the patients in Hanwell,
however, varies at different times, and may also
differ from that in other similar establishments. It
will be seen, by reference to the Table,* that there
were, in 1842, 936 patients in the Hanwell Asylum,
of whom 696 had been there more than two years,
and were reported incurable. The average duration
of the confinement of these 696 patients had been
upwards of six years and nine months. The yearly cost
of each patient at Hanwell, at the rate of 7*. a week,
and adding 41. per annum, paid by the county for repairs
and furniture, is 22^. 4*. : Each patient, therefore, who
has been confined during that period, will have cost his

* Table showing the length of time during which 936 Patients,
remaining on September 30th, 1842, had been in Hanwell Asylum.

1841.

1842.

Time.

Not exceeding 1 Month .

>J 3 5, .

)} 6 „ .

jj 9 jj •

„ 1 Year .

55 '^ 5J •

118

114

5) 3 „ .

4 „ .

152

55 ^ 55 •

143

55 6 „ .

55 7 55 •

)> ° 55 •

>I 9 55 •

10 „

117

11 „ ■

107

14 55 ■

Total ....

387

531

918

390

546

936

parish 1401. In reference to this calculation, it
should not be forgotten, that many pauper lunatics
have families, who, would no longer be thrown on
parishes for support, if their mental maladies could be
removed^ or even materially ameliorated.

Another fact connected with the condition in which
the insane poor are sent to Asylums is, we think, cal-
culated to have a very prejudicial effect. The Poor Extracts from

-r y-i • • -ii" -ijj J printed orders

Law Commissioners, in their printed orders and regu- ^^ -p^^^ l^^^
lations, have adverted to the 43tli section of the Commissioners.
Poor Law Amendment Act, which enacts that " no-
" thing in this Act contained shall authorise the deten-
*' tion in any "Workhouse of any dangerous Lunatic,
" insane person, or idiot, for any longer period than
" fourteen days ; and every person wilfully detaining in
" any "Workhouse any such lunatic, insane person, or
" idiot, for more than fourteen days, shall be deemed
" guilty of a misdemeanour." They remark upon this
clause, " The words dangerous lunatic, insane person, or
" idiot, in this clause, are to be read dangerous lunatic,
" dangerous insane person, or dangerous idiot, according
" to the opinion of the Law Officers of the Crown, given
" to the Poor Lai^ Commissioners." The following ex-
tract is taken from the printed directions of the Poor
Law Commissioners, as to the detention of lunatics in
Workhouses, dated the 5th of February, 1842. " From
" the express prohibition of the detention of dangerous
" persons of unsound mind in a Workhouse, contained
" in the clause just cited, coupled with the prevalent
" practice of keeping insane persons in the Work-
" houses before the passing of the Poor Law Amend-
" ment Act, it may be inferred that persons of un-
" sound mind, not being dangerous, may be legally
" kept in a Workhouse. It must, however, be remem-
" bered that with lunatics, the first object ought to be
" their cure, by means of proper medical treatment.
'* This can only be obtained in a well-regulated Asy-

" lum ; and tlierefore the detention of any curable
" lunatic in a Workhouse is highly objectionable, on the
" score both of humanity and economy. The Commis-
" sioners, indeed, believe that most of the persons of
" unsound mind detained in Workhouses, are incurable
" harmless idiots. But, although the detention of per-
" sons of this description in a Workhouse does not
*' appear to be liable to objection on the ground of
" illegality^ or of defective medical treatment, they
" nevertheless think that the practice is often attended
" with serious inconveniences, and they are desirous of
" impressing upon the guardians the necessity of the
" utmost caution and vigilance in the management of
" any persons of this class who may be in the Work-
" house."
Opinion of Poor "W'e entirely concur in the opinion expressed by the

Law Commis- -n -r r^ • • mi i i • <»

sioners as to Poor Law Commissioners, " That the detention of any

Lunatics m « curable lunatic in a workhouse is highly obiectionable,

VVorknouses. o j j '

" on the score both of humanity and economy." We
think, however, that they must be under some miscon-
ception as to the condition of lunatics in Workhouses,
when they represent them as being in general incurable
harmless idiots, and their detention not objectionable
on the ground of defective medical treatment.

The Poor Law Commissioners have, in their return of

Pauper Lunatics in England and Wales for the year

1842, returned the numbers of Lunatics belonging to

Parishes formed into Unions, at that time, at 6451,

Use of the term and of Idiots 6261. In these Returns, the word

Law Commis- " I^^iot," is used in a more extensive sense than that

sioners' returns Jn which it is usually employed by medical men, and

of Lunatics in i • i i

Unions. we think that the term ought to be confined to cases

of congenital idiocy. This will account for the very
large numbers which have been returned under this
description, and which, in point of fact, includes a
large number of lunatics of every class. The return
would represent that the lunatics of all descriptions

belonging to Parishes in Unions, throughout England
and Wales, exceeds that of the idiots only by 190.

In the year 1843, there were in the Chester Asylum
167 patients, of whom 39 (an unusually large propor-
tion) were idiots ; in the Bedford County Asylum
there were 140 patients, of whom 15 were idiots ; in
the Cornwall County Asylum there were 147 patients,
of whom 7 were idiots ; in the Dorsetshire County
Asylum there were 105 patients, including 2 idiots; in
the Kent County Asylum there were 253 patients, of
whom 4 were considered idiots. The above instances are
given by way of example, and there will be found to be
a very small proportion of idiots compared with other
lunatics in the other public Asylums in England.

As idiots are considered less dangerous than other Idiots often
lunatics, and may be regarded as being beyond the '^"S^''°"^-
means of cure, there is, perhaps, a larger proportion of
them in Workhouses and elsewhere, than is usiially met
with in County Asylums. Idiots, however, are by no
means to be considered as persons always harmless.
Two male idiots of the age of 18 were lately found in
an Union workhouse committing an unnatural o£fence.
They were taken before a magistrate, and were by him
sent back to the Workhouse as irresponsible persons.
Such individuals should be deemed dangerous, not only
in the ordinary but in a moral acceptation of the term,
and ought not, we think, to have been sent back to the
Workhouse. In the Leicester Workhouse, we found
(in Oct. 1843) a dangerous female idiot who had
knocked out the teeth of a child. There are constantly
instances of idiots exhibiting the most depraved as well
as the most dangerous propensities.

The Metropolitan Commissioners are directed by the Workhouses

act of the 5th & 6th Vic. c. 87, to visit houses visited by Com-

missioners.
licensed by Justices of the Peace for the reception of

insane persons, and also County Lunatic Asylums. The

gives Reports
concerning
Idiots and Lu-
natics in Work
houses.

Particular
instances speci'

act does not direct any visits to Workhouses. In the
year 1 842, however, we availed ourselves of all oppor-
tunities to visit such Union and other "Workhouses as
lay in our road. We obtained also your Lordship's
authority to visit, in the course of the last year, the
Union Workhouse at Bath, the Infirmary Bethel at
Norwich, and the Workhouses at Birmingham, Man-
chester, SheflS.eld, and at Portsea; and in consequence
of special information which we received, we were
induced to visit the several Union Workhouses subse-
quently noticed.
Appendix (C.) The reports given in the Appendix (C.) of the Work-
houses which have been visited by us, will show that
some of them contain not only incurable harmless idiots,
but numerous maniacal and dangerous lunatics of every
class.

In the Union Workhouse at Redruth, in Cornwall,
there were forty-one insane paupers, of whom six were
idiots. Several of them were violent, and at times re-
quired restraint. In the Union Workhouse at Bath, there
were twenty-one insane persons, of whom one female
was constantly under restraint; another was under
excitement, and secluded in a cell ; and one man had
been in the house four months without any medicine,
although his case appeared susceptible of benefit from
medical treatment. In the Leicester Union Workhouse,
there were thirty insane persons, of whom three males,
and nine females, were dangerous lunatics, in the strict
sense of the word, and most unfit inmates of the place
in which they were confined, and where, as we were
informed, they had been long detained, in spite of the
remonstrances of the visiting Surgeon, and some of the
Magistrates. In the parish Workhouse at Birmingham,
there were seventy-one insane persons, sul)ject to insa-
nity in various forms ; several of them being epileptics,
liable, after their paroxysms of epilepsy, to fits of

fied

raring madness, during which they were usually exces-
sively violent, and some of them occasionally under great
excitement, and furiously maniacal.

Whilst we feel it our duty to state to your Lordship
the condition in which we have found numerous
lunatics in the "Workhouses which we have visited, we
thoroughly appreciate the great difficulties which those
who administer the Poor Law have to encounter in the
disposal of pauper lunatics, by reason of the insufficient
provision made for their reception in proper Asylums.
We think, however, that the detention in Workhouses,
not only of dangerous lunatics, but of all lunatics
and idiots whatsoever, is highly objectionable.

The clause which is supposed to sanction the confine- Confinement in
ment in Workhouses of lunatics, without adverting to Lunatics^^ob-**
the probability of their being curable or not, provided jeetionable.
they be not dangerous, is, in our opinion, impolitic,
and open to serious objection. Although a patient may
not be violent or raving, he may require medical treat-
ment, and it is at the beginning of attacks of insanity,
when the causes of the disease are in most powerful
operation, and the symptoms are developing themselves,
that the skill of a medical officer experienced in this
disease is most required. Our objection to the clause
of the Act to which we have referred is, that it has a
tendency to impress upon those who have the care of
the poor, the belief that there is no harm in keeping
lunatics away from Asylums so long as they are not
dangerous, and thus to combine with the other causes
which we have pointed out in producing that incurable
condition in which pauper lunatics are so often sent
to Asylums. The clause seems, moreover open to this
observation, — if it really sanctions the detention of
harmless lunatics, — namely, that the Parish Authorities
may take advantage of it to deprive persons of their
liberty, although they would do no harm if at large.
, If, notwithstanding these objections, a necessity
H 2

100

Exercise and
occupiation
should be pro-
cured for harm-
less Idiots.

Formidable
increase of
Incurable
Patieiits.

exists for detaining any of the insane poor in Work-
houses, care should be taken to secure for them proper
treatment, by persons experienced in the diseases of the
insane. The law has provided that all houses licensed
for the reception of lunatics, shall be regularly visited
by a medical man, and that such medical man shall
make and sign a statement of the health of all the
patients once in every week. The ordinary medical
attendants, however, of Union and other Workhouses,
are not always persons conversant with the treatment
of insanity. Even for harmless incurable lunatics,
proper means of exercise and occupation ought to be
provided, and experienced attendants ought to be em-
ployed. Yet, at the Bath Union Workhouse there
were nine Insane females under the care of an aged and
' feeble woman, who was stated to be upwards of ninety
years old. One woman under her charge was always
confined in a strait waistcoat, and another was in a state
of great excitement, and secluded in a solitary cell.
When this feeble woman was unable to manage the
female patients, her practice had been to call in the aid
of an old man who had the charge of the male lunatics.
In the Leicester Workhouse, there were nineteen female
lunatics, some of whom were extremely dangerous.
Some of these persons were found shut up in a small
refractory ward, without any attendant. We were told
that it was the duty of a female servant to look in upon
them once an hour, but that she feared to remain with
them.

It will be seen from the foregoing statements, to what
a formidable extent the number of incurable patients
have increased in many of the public Asylums. And
this seems to have arisen principally from two causes,
viz. : — 1st. The detention of patients in Workhouses or
elsewhere, until they were past the chance of recovery ;
and 2ndly. The want of any separate Establishment
to which patients could be sent when they became
incurable.

101

It is manifest, indeed, either that County Asylums Increase to be
must, in their original construction, have been made gonjg measure
inadequate for their purpose ; or that, from some cause, *", system of

T- ^ ^ admission m

insanity has since increased. And there can be no large Asylums.
doubt, we apprehend, but that there has been a great
increase in the numbers of lunatics, and that this is to
be ascribed, in some measure, to the system of admis-
sions and general arrangement which prevails in the
large Asylums, and which has prevented the poor and
the public from obtaining the full benefit intended to
be afforded by those Institutions. Should the system of
detaining curable patients from Asylums until they are
beyond cure, and sending thither those only who are
incurable, still continue, it is difficult to foresee the
extent to which the numbers of incurable Lunatics may
increase, especially in some of the populous Counties.

If incurable Lunatics should be allowed to reside in
Unions or Workhouses, it is indispensable that they
should have separate Wards and Airing-grounds, to-
gether with proper Diet and superintendence, and that
these Wards should be visited regularly, like other
Lunatic Asylums. We think, however, that it would
be far better that they should be provided for at a
distance from the ordinary Poor, to whom they might
be a subject of annoyance, and who might themselves
become a source of irritation to the Lunatics. And
there can be no doubt, we apprehend, but that the
comfort and proper treatment of Lunatic Patients
would be secured much more effectually in a distinct
Establishment. Whether the existing Asylums, which Question
contain a very large number of Patients, can be rendered ^^Jj^^^,i^^l '

efficient Hospitals for the treatment of curable Patients can be reudered

. efBcient Hospi-

only ; or whether they may not be exclusively appro- tals for curable

priated advantageously to the use of incurable Lunatics,

is a question that may deserve future consideration.

When we call your Lordship's attention to the

fact that the number of Pauper Lunatics in England

Patients.

102

and Wales appears to be about 17,000, and that there
is accommodation in county Asylums for not more than
4500, we do not recommend the providing public
Asylums for such a number of persons upon the expen-
sive scale on which county Asylums have hitherto been
Suitable places erected. We submit, however, that it is the duty as

for reception of .

recent cases Well as the interest of the public to provide suitable
*d d th^'^r places, in every county or within certain districts, where
delay. recent cases may be received without delay.

III.

FORMS OF DISEASE, MEDICAL TREATMENT, DIET,
AND CLASSIFICATION.

Principal forms ^^ ^^"^® thought it expedient in this place to dis-
of Insanity dis- tinguish the principal forms of Insanity which are

tinguished. * . . , .

usually met with in Lunatic Asylums, in order to
render more clear and intelligible the statements which
we are about to make respecting the classification and
treatment of their inmates. They may also be useful
in illustrating the Statistical Tables which wiU be
found in the Appendix.

The principal forms are comprehended, in the Tables
which accompany this report, under the following
heads : —

I. Mania, which is thus divided : I

1. Acute Mania, or Raving Madness.

2. Ordinary Mania, or Chronic Madness of

a less acute form.

3. Periodical, or Remittent Mania, with

comparatively lucid intervals.
II. Dementia, or decay and obliteration of the intel-
lectual faculties

103

III. Melancholia.

IV. Monomania.
V. Moral Insanity.

The three last mentioned forms are sometimes com-
prehended under the term Partial Insanity.

VI. Congenital Idiocy.
VII. Congenital Imbecility.
VIII. General Paralysis of the Insane.
IX. Epilepsy.

To these heads may perhaps be added "Delirium
Tremens," since it is mentioned, as a form of Insanity,
in the Reports of some Lunatic Asylums.

A few brief descriptions of the disorders to which
these terms are appropriated, may be deemed requisite
by way of explanation.

I. Mania. — This term is used to designate a par- (N^jjejal defini-
ticular kind of madness, as affecting all the opera- tion of Mania,
tions of the mind. Hence the term Total or General
Insanity is used as synonymous with Mania. Maniacs
are incapable of carrying on, in a calm and collected
manner, any process of thought; their disorder for
the most part betraying itself whenever they attempt
to enter into conversation. It likewise affects their
conduct, gesture, and behaviour, which are absurd and
irrational ; their actions being characterized by great
restlessness, appearing to be the result of momentary
impulses and without obvious motives. Mania is also
accompanied by hurry and confusion of ideas, and by
more or less excitement and vehemence of feeling and
expression. When these last symptoms exist in an
excessive degree, the disorder is termed Acute Mania or
Raving Madness.

1. Acute Mania or Raving Madness is the first stage Acute Mania.
of the disease, which often becomes gradually milder in
its character, and is then termed Chronic Mania or

104

simply Mania. In other cases, the disposition to high
excitement or raving continues through the whole
course of the disease, which sometimes becomes fatal
through the exhaustion occasioned by perpetual agita-
tion and want of rest. It is also generally attended
with considerable disturbance of the vital functions.
Chronic Mania. 2. The Chronic Form of Madness is attended with less
excitement of the' passions, less rapidity of utterance,
and less violence of action. In this stage, the disorder of
the mind is not always immediately perceptible ; but it
soon becomes apparent that the patient is incapable of
continued rational conversation or self-control, and that
his acts are the results of momentary caprice, and not
governed by rational motives. A great proportion of
Maniacs labour under Illusions and Hallucinations^ or
false impressions as to matters of fact, but in these
illusive notions there is no consistency or permanence.
Patients labouring under this chronic form of Mania
are often tolerably tranquil and harmless. Many of
them are capable of being employed in agricultural and
other active pursuits, and of amusing themselves by
reading, music, and various entertaining games. A
great proportion of the inmates of Lunatic Asylums
belong to this class. However quiet and manageable
they may appear to be under the authority and super-
vision to which they are subjected in an Asylum, they
are quite unfit to be at large and to mix with ordinary
society.

3. Intermittent Mania or Madness attended with
lucid intervals is by no means so frequent as might
be inferred from the writings of authors on medical
jurisprudence. Some medical writers, of considerable
note, have denied the existence of lucid intervals alto-
gether. The fact is, that in all large Asylums, there are
patients subject to occasional paroxysms of raving mad-
ness, but who have intervals of comparative tranquillity
and rest. It generally Iiappens that after the alterna-

Intermittent
Mania.

105

tions of raving fits and periods of tranquillity have
continued for some time, the intervals become less
clearly marked, and the mind is found to be weak-
ened, the temper more irritable, and both ^the feelings
and the intellectual faculties more and more disor-
dered.

Recurrent Insanity differs from Intermittent Mania, Distinction
though often confounded with it. ' In Intermittent jgnt Insanity
Mania paroxysms occur either after regular or irre- ^^^ Intermit-

^ •' _ ° tent Mama,

gular periods, and this is the ordinary character of

the disease. Recurrent Insanity is a name applied to

any form of mental disorder, when the patient recovers

perfectly, but suffers from relapses after considerable

periods of time.

II. Dementia. — Chronic and protracted mania is fre- Dementia,
qnently the prelude to a decay and final obliteration of
the mental faculties, which is termed Dementia.

Dementia differs from all other forms of insanity. It
differs from Mania, in which the intellectual powers
still exist, though they are exercised in a confused and
disordered manner. It differs from Idiocy, in which
the powers of the mind have never been developed,
while in Dementia they have been lost.

Dementia is, in some instances, the primary form of
mental derangement, and its phenomena make their
appearance in the first onset of the disease. Cases of
this kind are chiefly from causes of a depressing nature,
such as deep and overwhelming grief, extreme poverty,
destitution, and old age. In those instances in which
dementia is the sequel of protracted mania, it is not
easy to determine the point at which mania ends, and
dementia begins. It is sometimes, also, the sequel of
epilepsy, apoplexy, paralysis, and other affections of the
brain.

In most large Asylums the prevailing forms of Mania and
insanity are Mania and Dementia. In the collective I^^™<'°ti* pr«"

"' vailmg forms of

numbers of Patients in the Lancaster County Asylum, Insanity in

large Asylums.

106

the Superintendent has furnished the following state-
ment, viz., Out of 619, reduced to 580 by the omission
of 39 doubtful caseS; there were labouring under mania
235j and dementia 183=418, which is about two ■
thirds of the whole number of the Patients.
Melancholia. ; HI, Melancholia. — A considerable proportion of the
inmates of all extensive Lunatic Asylums, are the
Melancholies ; among whom there are several degrees
and varieties. Some patients display merely lowness
of spirits, with a distaste for the pleasures of life,
and a total indifference to its concerns. — These have no
disorder of the understanding, or defect in the intellectual
powers, and, however closely examined, manifest no delu-
sion or hallucination. This state often alternates with an
opposite condition of the mind, namely, one of buoyancy
of spirits, and morbid activity^ It is thus frequently very
difl&cult to determine in what degree Melancholy, when
it exists without delusions, constitutes insanity. A
great number of persons whose disorder is precisely
that which is above described, and who betray no
particular error of judgment or hallucination, are con-
fined in Lunatic Asylums as a precaution against suicide,
to which they are prone, in many instances, from a
disgust of life.

Another class of Melancholies derive their grief and
despondency from some unreal misfortune, which they
imagine to have befallen them. Many are convinced
that they have committed unpardonable sins, and are
doomed to eternal perdition. Others believe themselves
to be accused or suspected of some heinous crime, of
which they are destined to undergo the punishment ;
and of this they live in continual dread. Some
fancy that they have sustained great pecuniary losses,
and are utterly and irretrievably ruined. A numerous
class of melancholy patients live under the impression
that they labour under some terrible bodily disease.
Many of them have, in reality, some complaint of

107

which they magnify the symptoms : they fancy every
trifling sensation of a painful kind to be certain indica-
tions of their incurable distemper, which they often
attribute to some fantastical cause.

Melancholy patients require particular care and Particular care
constant inspection, on account of the frequency of melancholy

suicides among persons of this class. In the Report patients to pre-

. , . , . ^ vent suicide.

of the Patients admitted into the Jforthampton Asylum

from August 1838, to November 1843, out of 118
cases of Melancholia, a suicidal propensity had been
discovered in sixty-four.* The suicidal propensity is
not, however, restricted to this class of patients. In a
late annual Report of the Lancaster County Asylum,
there are only forty-five cases of Melancholia men-
tioned, while it is stated that a suicidal propensity
had been manifested by 105 out of the total number
of 619.

IV. Monomania. — Monomania, properly so termed, is Monomania.
a form of Insanity, which, from the attention given to it,
might be supposed to be of more frequent occurrence
than it really is. The term is professedly given to cases
in which the intellectual faculties are unimpaired, except
with relation to some particular topic. Instances, indeed,
are continually occurring in which some particular im-
pression of a delusive and insane kind, occupies the atten-
tion of the patient and is uppermost in his mind, but
unless the power of reasoning correctly on subjects un-
connected with the illusion, is retained, the disorder is
not a case of Monomania, or " Partial Insanity."

A frequent illusion of Monomaniacs is, that they hold
conversation with supernatural beings.

In most instances of Partial Insanity Melancholy

* It is remarkable that the excess of suicidal cases prevailed in the
pauper part of the establishment. Thus, in forty-two cases of Melan-
cholia, occurring among private patients, there were only eighteen
suicidal cases, while in seventy-six among the paupers, forty-six
were suicidal.

108

connects itself with the subject of delusion. These cases
properly belong to Melancholia.
Moral Ineanity. V. Moi'al Insanity. — This term is used to designate
a form of mental disease in which the affections,
sentiments, habits, and, generally speaking, the moral
feelings of the mind, rather than the intellectual
faculties, are in an unsound and disordered state.
The common distinctive character of all these cases is
of a negative kind, viz. — that the faculties of the under-
standing remain apparently imimpaired, and that no
delusive impression can be detected in the mind of the pa-
tient, which may account for the perversion of his moral
dispositions, affections, and inclinations. Cases of this
description were formerly looked upon as unaccountable
phenomena. They are, however, now recognised as a
distinct form of mental disorder in nearly all the public
Asylums. They are characterized by a total want of
self-control, with an inordinate propensity to excesses
of various kinds, among others habitual intoxication.
This is often followed by an attack of Mania, which,
however, speedily subsides when the patient is con-
fined, but is generally reproduced, by the same exciting
cause, soon after he is discharged.

Among the Female Inmates of Asylums, there are
many whose disorder principally consists in a moral per-
version connected with hysterical or sexual excitement.
Congenital VI. & VII. Congenital Idiocy, and Congenital

gerdtel T be"" Imbecility. — Congenital Idiots are persons whose intellec-
cility- tual faculties have never been developed.

Congenital Imbecility is the result of some original
defect, which renders the mind feeble in all its opera-
tions, though not altogether incapable of exercising them
within a limited sphere. There are many degrees of
Imbecility, but the examples chiefly found in Lunatic
Asylums are persons labouring under this weakness in
an extreme degree. It is evident tliat more discrimi-
nation ought to be used than has hitherto been practised

109

in solecting from persons of this class proper objects for
confinement.

VIII. General Paralysis of the Insane^ and other General Para-
forms of Paralysis complicated with Insanity. in^sane

Paralysis is not unfrequently complicated with In-
sanity, and is almost an invariable indication that the
case is incurable and hopeless, marking the existence of
organic disease in the brain.

In some instances, Insanity is the consequence of an
attack of apoplexy, or of hemiplegia. This happens
more especially in aged persons.

In others, apoplexy or paralysis supervenes on pro-
tracted mania or dementia.

The most strongly marked case of the complica-
tion of paralytic symptoms with those of mental
disorder, is the disease termed General Paralysis of the
Insane. This is more properly to be considered as an
affection distinct both from ordinary paralysis and from
insanity. The paralytic symptoms in this affection
are sometimes observed to precede those of mental
disturbance ; and others they follow. General paralysis
of the Insane seldom occurs in females, but mostly
in men, and is the result almost uniformly of a
debauched and intemperate life. Its duration is
scarcely ever longer than two or at most three years,
when it generally brings its victim to the grave. The
onset of the disease is distinguished by an impediment
in the articulation, an effort is required in speaking,
and the words are uttered with a sort of mumbling,
and stammering. At this period, there is no other
perceptible sign of paralysis, and the mobility of the
limbs is not at all impaired. In a second stage, the
patient is observed to have a tottering gait : the limbs
are weaker than in health, especially the lower extre-
mities, while the functions of the organs of sense are
likewise enfeebled. In the progress of time, a third
stage appears, during which the victim of this malady

loses not only the power of locomotion, but can
neither feed himself nor answer the calls of nature. He
becomes more and more weak and emaciated, but
generally perishes under some secondary disease, such
as gangrene, sloughing of the surface of the
body, or diarrhoea, unless he be cut off at an earlier
period by an apoplectic or epileptic attack, to which
these patients are very liable. The disorder of the mind
is peculiar in this affection. It is generally a species
of monomania, in which the individual affected fancies
himself possessed of vast riches, and power.

This specific form of Insanity has been known for
some time in France, by the Physicians of which coun-
try it was first described : its existence has been more
recently recognised in the English hospitals, and some
instances of it are reported in the enumeration of cases
transmitted from most of the County Asylums. The
proportions which these cases bear to the whole num-
ber of admissions is very different in different Asylums;
as will appear by reference to the following Table :

CASES OF GENERAL PARALYSIS.

In 213 admissions into Han well Asylum, . 32
In 120 „ „ Surrey . .16

In 619 „ „ Lancaster . . 13

Epilepsy. I^- Epilepsy. — In most of the Lunatic Asylums

there are some, and in the large Asylums many persons
confined among the insane who are subject to epilepsy.
For this disease, unfortunately, is often complicated
with insanity. There are, however, some Epileptics
in these Asylums who are not insane, or in any way
disordered in mind during the intervals of their
paroxysms.

Epilepsy is complicated with defects or disorders of
the mind, in various ways.

Epileptic Idiots. !• Epileptic Idiots. — Persons whose intellectual facul-
ties have never been developed. They are not mate-

Ill

rially different, as regards their mental deficiency, from
idiots not subject to Epilepsy ; but they require greater
care, on account of the accidents to which this disease
renders them liable,

2. Epileptics who are imbecile or demented. — When imbecile or
paroxysms of Epilepsy are very frequent and severe, and p"^.^"'^<l P^"
the disease is of long duration, it generally impairs the
intellectual faculties. Torpor, weakness and imbecility

come on, which, if the patient survives under his dis-
ease for many years, terminate in fatuity, similar in every
respect to the fatuity which ensues in protracted Mania.

3. Epileptic Mania. — Some persons subject to severe Epileptic Mania,
paroxysms of Epilepsy without suffering obliteration of

their intellectual faculties, and even without obvious dis-
order of the mind during the intervals of their paroxysms,
are nevertheless subject to occasional fits of a maniacal
character. It is an observation frequently made by the
attendants of Asylums, that when the Epileptic fits are
coming on, such persons are irritable, morose, malicious,
and sometimes exceedingly dangerous. During these
periods. Epileptics are prone to violence, and sometimes
perpetrate the most atrocious acts. Many instances are
upon record of such persons, at a time when their dis-
order had been in abeyance, or even supposed to have
ceased altogether, having been seized with a sudden
impulse to commit homicide, infanticide, suicide, or to
set fire to houses.* In other instances, the mental
disorder of Epileptics has the form of acute mania, or
rather of raving' delirium. The patient, generally a
day or two after the attack of Epilepsy, sometimes

* Shortly before the second visit of the Metropolitan Commissioners
to the Asylum at Gateshead Pell, a man had escaped, who it was
thought had become nearly convalescent, and who was accordingly
employed in the grounds belonging to the house. He was apparently
so far recovered, that the Parish Officers (without reference to the
Medical Visitor) determined to leave him at large. On the third night
after his escape, he murdered his wife and daughter. His case was one
of epileptic mania.

112

Epileptics
whose intellects
are unimpaired.

immediately after It has ceased, is seized with a sudden
fury, during which he sings, roars, shrieks, or resembles
a man in a violent fit of intoxication. The species of
madness which is complicated with Epilepsy is one of
the most mischievous and dangerous forms of the disease.
But the instances of this affection bear a very small
proportion to the cases of Epilepsy in general.

A great number of instances of Epilepsy, however, are
well known to exist without any considerable disorder
of the mind. Persons subject to occasional paroxysms,
or those of infrequent occurrence only, are, during the
intervals, in a tolerably perfect possession of their intel-
lectual faculties, and are capable of following their
ordinary pursuits.

Adult persons of this description are scarcely to be
found in Lunatic Asylums, but we have been informed
that boys and girls, when they have become a source of
anxiety and trouble to their parents, as well as danger-
ous to themselves, have sometimes been sent by Boards
of Guardians to Asylums for protection. We do not,
however, consider this a sufficient reason for associating
this class of epileptics wdth the Insane. Where a pro-
per classification exists, the Epileptics are placed in
wards by themselves, or are separated from the insane ;
but there are many Lunatic Asylums where this regu-
lation is entirely neglected.

The proportion of Epileptics to the other inmates is
very considerable in some Asylums, as may be seen by
the following statement.

Numbers

House.

Epileptics.

Hanwell

Bethnal Green . . .
Hoxton House ....
Lancaster ....
York W. Riding . . .

Kent

Chester

975
562
396
611
433
249
164

80
40
24
40
23
15
12

63
19
20
23
16
14
6

113

X. — Delirium Tremens. — Instances of Delirium Delirium tre-
Tremens are occasionally, though not often, seen among
inmates of Lunatic Asylums. The disorder is well
known. It is the result of intemperance, and frequently
supervenes on a fit of intoxication. It is named from
the muscular tremor and agitation which accompanies
it, and the peculiar affection of the mind, resembling
the delirium of fever rather than the phenomena of
Insanity. It is not a disease of long duration, but ter-
minates, for the most part, in a short period, either in
death or in recovery. Hence, there are comparatively
few cases of this description in Lunatic Asylums.

Medical Treatment.

Having thus described the different forms in which Medical treat-
Insanity manifests itself, we now proceed to consider i^ms considered
the Medical Treatment to which the Patients confined
in Lunatic Asylums are subjected.

In our visits to these Asylums, both public and
private, we have been careful to make inquiries as to
the methods of medical treatment adopted by the pro-
prietors or superintendents, or by those persons to
whom the medical care of the patients has been confided.
We have occasionally found some difl&culty in obtaining
information on this subject. In soqae instances, we
have not seen the medical ofiicers, and we have derived
our information, in such instances, from the proprietors,
superintendents, and the inmates of the respective
Asylums. Yet, on the whole, we have obtained a
tolerably correct knowledge of the state of these esta-
blishments, with regard to the manner and degrees in
which the resources of medicine are applied in them to
the cure and alleviation of mental diseases.

A great difference prevails, in this respect, in the Difference pre-
different classes of Lunatic Asylums. The licensed ""^f""^ 7 ^'^""

•^ ent Asylums.

houses, containing fewer than 100 patients, in which the

residence of a Medical Officer is not required, by the

114

Act 2, 3, Will. IV. cap. 107, within the walls of each
Establishment, and which, in some instances, are linder
the management of persons entirely without medical
education, are visited generally by medical practitioners
in the neighbourhood. These visits to the Asylums are
usually made twice in a week, and in some instances
more frequently.

In some Asylums, the whole system of management
appears to have been constituted less with regard to
the cure of insanity, and to the restoration of lunatics
to health and society, than to their seclusion and safe
custody. Occasional doses of medicine are administered,
when incidental deviations from bodily health or any
contingency calls for their use, but the application of medi-
cine and other restorative means, on any determined
plan, with a view to promote recovery, and to restore
the mental faculties to a sound state, appears in some
Asylums never to have been contemplated. To accom-
plish this object, the residence of a Medical man on the
spot, or in the immediate vicinity, is very essential ;
and here we cannot but notice the following extract from
Report of Com- a Report of the Commissioners who visited the Norfolk
Norfolk' Asy^ County Asylum in August, 1843, which will point out
lum- the evils likely to be contingent on this arrangement.

" The most serious defect in this Institution, and one
"• which may be attended with the most mischievous,
" if not fatal, consequences, is the want of a Resident
" Medical Officer. On this subject, we cannot but
" notice, as a singular anomaly in the law, that, whilst
" it is required in every Licensed House, containing
" 100 Patients, that there shall be a Resident Physician,
" Surgeon, or Apothecary, there is no similar provision
" as to County or Subscription Asylums, or public
" Hospitals. The liability to apoplexy, and the pos-
" sible occurrence of cases of suspended animation from
" strangling may be mentioned as among the many
" reasons calling for the constant attendance or immediate

115

" vicinity of a Medical man. We put some questions to
" the Superintendent, as to what he would do in cases
" such as we have described. His answer was that he
" would not venture upon the responsibility of acting or
" applying remedies, that he could not bleed, and had
" no knowledge or experience, medical or surgical.
" Upon asking, then, what steps he would take in
" such cases, we were told that he would immediately
" send to Norwich, the nearest place, three miles dis-
" tant, for one of the Medical visitors. He subsequently
" directed our attention to a pony on the lawn,
" which he informed us was constantly ready to be
" saddled as occasion required."

It must be observed, that of several private Asy- General charac-
lums the proprietors are physicians, who reside within ^^r of Medical

1 • 1 T 1 T\ir CI ^^"^ attached

their own establishments. Many of them are able to Asylums.
and well-informed men in their profession, and ap-
pear to treat their patients with judgment and skill.
Many of the Superintendents of County Asylums, and
some of the Medical Officers in those licensed houses
which, from their containing one hundred patients
require the residence of such an attendant, are men
intelligent, and active in doing all that is practicable
towards the restoration of their patients.

The Medical Officers residing in the Asylums have
been led by personal observation and experience, nearly
to the same conclusions, as to the most efficacious treat-
ment of Insanity; or, to speak more precisely, of adminis-
tering the aids of medicine and regimen to those classes
and descriptions of persons who are principally the
inmates of public Lunatic Asylums. Amongst the Causes of In-
most frequent causes of Insanity in Paupers, are ^'^^^^7 ^'^ P^"-
habitual intemperance, poverty and destitution, grief,
disappointment; and, we fear, in some instances want
of sufficient sustenance. These causes act with dif-
ferent degrees of influence on different individuals,
according to the various states of their constitution,
i2

116

but they have all a tendency to bring the body
into a state of weakness and exhaustion. This is
greatly aggravated by the insane poor being very
generally sent in the first place to workhouses and
other improper receptacles, instead of to Asylums, where
they might be immediately subjected to medical
treatment, at a time when the disease is known to be
curable in a large proportion of cases-
Curative treat- ^^ ^^ ^^^ general opinion of the best-informed medi-
meut of Pauper (,^1 attendants on Lunatic Asylums that the most'

Lunatics.

successful method of attempting the cure of pauper

lunatics in public hospitals, exhausted and destitute as
they often are, is to obviate the state of body which
poverty and distress have a tendency to induce. This
is best effected by a restorative plan, and by means
calculated to reproduce a vigorous state of bodily health.
For this purpose a nutritive and tolerably full diet is
allowed, consisting of a considerable proportion of
animal food, wholesome digestible bread, milk porridge,
or milk thickened with various farinaceous substances,
and good broth. To these a moderate quantity of malt
liquor, ale, or porter, is added in most cases, and in
some extreme instances, wine and other stimulants.
Warm clothing and bedding, and a moderately warm
and dry atmosphere, are indispensable auxiliaries for
promoting the comfort and cure of lunatics, in whom
the circulation is languid, and who for the most part
are chilly, and suffer much from exposure to cold and
damp air. Exercise in the open air in cheerful airing-
grounds ; baths, either warm or cold, according to
the state of the circulation and the habitual tempe-
rature of the skin; frictions promoting cleanliness and
dryness of the surface of the body, and tending to keep
up the action of the blood-vessels to a certain healthy
standard, are generally found to promote the restora-
tion of patients whose cases are of a curable descrip-
tion.

117

The whole of this plan is said to prove beneficial
only in those cases which are free from the ordinary
signs of congestion in the brain, and from tenden-
cies to epilepsy and paralysis. When these exist,
they must be treated by appropriate remedies, such as
topical bleedings and counter-irritations. In the cases
before alluded to, tonic and stimulant medicines, and
all the remedies which promote healthy digestion and
a due circulation of blood to the extremities, are said to
be productive of beneficial results. The tonic remedies
most in use are carbonate of iron, cinchona, sulphate of
quina., gentian, combined with aloetics when required
by the state of the natural functions, or with astringents,
when, in cases of great debility and exhaustion, there
is a tendency to diarrhoea, or dysentery. A moist
or relaxed state of the skin, with cold extremities;
a shrunk and shrivelled surface, with a livid and
blotchy, or pale and yellow complexion and feeble
circulation, are well known to frequently co-exist
with insanity, and are especially noted in those cases
which are the result of depressing agencies. In this
state of the system, great advantages are said to arise
from the use of carbonate of ammonia, given in fre-
quent doses, and continued for a considerable time.
Emetics and powerful purgatives are said to be rather
injurious than useful, in the forms of disease now
described, except where any temporary complaint in-
dicates the necessity of having recourse to them. It is
the testimony of the best-informed among the Medical
Superintendents of Asylums, that the restoration of
bodily health is frequently accompanied by a marked

improvement in the state of the mental faculties. We Regulations as

to treatment in
must not omit the fact, that although a very general some Asylums

agreement exists among the intelligent Medical Officers ^* ^a"fn<=e with

° Ob general opmion ;

of Lunatic Asylums, as to the most efficient method
of treatment for the cure or relief of the class of
patients above described, there are some remarkable

118

exceptions, and that the regulations of some Asylums
are quite at variance with the general opinion.

Diet.

first, as to diet ; In the first place as to diet. We have remarked
that nothing is more important than a sufficient and
appropriate diet in the treatment of lunatics. It is
indeed evident, that nothing can be effected vnthout
an ample supply of proper food, in the restoration of the
patients from that state of physical weakness and ex-
haustion, which is the condition of the majority among
the inmates of pauper asylums.

It is worthy of remark, that in two of the County
Asylums, viz. those of Middlesex and of Dorset, the
diet of the patients was sometime since improved by an
increased allowance of food, and that in both of these
asylums, there was recorded after this alteration an
increase in the number of recoveries. Complaints have
been made of the too great use of broths and gruel : in
consequence of which, at Hanwell, a meat dinner has
been substituted for pease-soup, on one of the two days
on which the latter was previously given. It has been
suggested to us, that regard should be paid to the nature
of the food to which the patient was accustomed before
his confinement.

In the private Asylums admitting pauper patients,
there is considerable diversity with respect to the allow-
ance of food. In many of these establishments (and
this is the case even in some which are defective in
other particulars), a tolerably good and liberal diet is
furnished to the patients. In many asylums a fixed
quantity of beer is furnished to the patients, and in all
these asylums it is the opinion of the proprietors that
this allowance is beneficial. There are other asylums
where beer is allowed to those who will employ
themselves chiefly in out-door labour. In many in-

119

stances no malt liquor is furnished to the patients : this
is observable in many of the large asylums in the North
of England. In the Asylum of Lincoln it was thought
advisable, sometime since, by the Committee of Manage-
ment, to increase the quantity of nutritious food allowed
to the patients, as a substitute for fermented liquors for-
merly allowed to the patients. In the Leicester Asy-
lum we were informed that the diet was varied with re-
gard to the different classes of patients ; a poorer or
lower diet being laid down for the Epileptics and Incu-
rables than for others.

The supply of a sufl&cient quantity of proper food ap- proper diet an

important aid to

pears to us one of the most important aids towards the ^^.g ^j, rgHef •
relief or cure of insanity. We have received assurances
from various intelligent superintendents of Asylums,
that this disease has been frequently alleviated, and
repeatedly cured, solely by increasing the quantity of
wholesome food. The want of food is considered by
the Superintendent of the Lancaster Asylum to have
been the exciting cause of insanity in many cases which
have come under his care. In some private Asylums,
where a low scale of diet prevails, the small sum
allowed for each patient has been pointed out, by which
it appeared that the proprietor of the Asylum would
have been scarcely remunerated for a more liberal supply
of food. It is our opinion that the amount of food
allowed to pauper lunatics, and the rate of payment
made for them in private Asylums, should be under
the control of official visitors. The Dietaries of the
Pauper Patients in the several county and principal
other Public Asylums, and a selection from the Diet-
aries of the private Asylums receiving Paupers, will
be found in Appendix E to this Report.

The next subject to be noticed is that of temperature, second, as to
A • • T 11 • 1 1 •!• temperature.

A most important aid towards the restoration of debili-
tated Insane patients to bodily health, and therefore
towards their ultimate recovery, is afforded by a pure, dry,
and warm atmosphere. External warmth is required by

1-20

the general state of circulation and of the skin, in a great
majority of cases, and patients are known to suffer
much from being in a cold or damp atmosphere.* In
the Lincoln Asylum the lower galleries were found
cold at our different visitations, and we were surprised
to observe, among the standing regulations of the Com-
mittee of Management, an express prohibition to the
admission of heated air, although in the galleries no
means existed of raising the temperature to a proper
degree. It was quite evident to us that much needless
suffering must be occasioned to the patients by this pro-
hibition.

In some of the smaller private Asylums, the apart-
ments are not only cold, but extremely damp. These
defects are calculated to occasion the prevalence of
diarrhosa, dysentery, and pulmonary complaints, which
are among the most frequent causes of death in Luna-
tic Asylums.

Meaus of exer- The means of exercise in the open air are very defec-
tive in many of these Asylums. Even where there are
extensive pleasure-grounds around the houses, pauper
patients are in some instances prohibited from availing
themselves of these advantages, and are shut up in small
and cheerless yards.

Use of opiates in The utUity of opiates as a remedy in cases of insanity,
is a question on which we have found some diversity
of opinion among the Medical Superintendents of Lunatic
Asylums. Some abjure the use of all narcotic medi-
cines, while others look upon sedatives as a most valu-
able resource in cases of agitation and excitement, and
have recourse to them on all occasions, when want of
sleep and restlessness produce debility and exhaustion.
This last practice seems to be gaining ground. Prepa-
rations of opium and other sedatives, given in repeated -
and sufficient doses, are thought by the best-informed
practitioners, who conduct the medical treatment in

* This subject is adverted to farther ia the section on Warming and
Ventilation.

cue.

Insanity.

121

the large Asylums, to be of great efficacy in subduing
excitement and agitation, and conjoined with the
use of baths, cold applications to the head, and the
use of anti-spasmodics and aperients, are said to
promote the cure of Mania in the early and acute
stages. Several instances are recorded, at the Licensed
Houses of Bethnal Green, of Patients having been
restored to reason, in a, very short time, by the skilful
administration of opiates. The Committee of Manage-
ment of the Lincoln Asylum, among other regu-
lations for the guidance of their Medical Officers, have
established the following rule, — that " the process of
" subduing violence by the use of tartarised antimony,
"or of narcotics, the practice of enforcing sleep by
" opiates and courses of drastic medicines, are hereby
" interdicted, except in special cases otherwise medically
" requiring the same."

The foregoing remarks upon the medical treatment
practised in various Asylums must be understood to
apply principally to recent cases. In chronic forms of
the disease, although medicine alone is found to be of
less efficacy, much is stUl accomplished by skilful
medical superintendence, combined with judicious moral
treatment.

Pursuant to the Act 5 & 6 Vict. c. 87, sect. 8, Medical treat-

. , T 1 . . ment not sub-

we have inquired whether any medical treatment stituted on
was in any of the Asylums substituted for coercion, coercion.
It has been reported to us that no such system prevailed
in any of the Asylums: but that the use of emetic
tartar, of sedatives combined with aperients, and cold
applications to the head in recent cases of high excite-
ment, has occasionally rendered mechanical restraint
unnecessary.

Classification of Lunatics.

One of the most important ameliorations, introduced Classification of
. . - , . . Lunatics.

during late years into the treatment of the insane in

Lunatic Asylums, consists in the proper classification

122

Most beneficial
in curable, re-
quisite in incu-
rable cases.

Separation of
dangerous Lu-
natics from
others.

and distribution of patients into different departments.
In former times the inmates of these houses, if not
confined in solitary cells, were seen crowded together
indiscriminately ; tranquil, and often timid and sensi-
tive patients being assembled in the same apartments
with violent and noisy maniacs. If any classification
existed, it was little more than a separation of per-
sons according to their various grades in society ;
the poorer classes being divided from those who, by
reason of larger payments, were considered to be entitled
to greater personal comforts. The classification of
lunatics, now generally adopted in well-regulated
Asylums, is founded on a different principle. It consists
in the distribution of patients with reference to their
mental disorders, and in associating those persons whose
intercourse is likely to be mutually beneficial, and in
separating others who are in a state that renders their
society a source of mutual irritation and annoyance.

The distribution of lunatics, on this principle, is found
to have a most beneficial influence in promoting their
recovery, when their cases admit the hope of cure, and
in incurable cases it is equally requisite, with a view to
the personal security of the patients, as well as their
comfort and tranquillity. The rules desirable to be ob-
served, in order to obtain the most advantageous system
of classification, have been mainly founded upon experi-
ence. They have been, as yet, carried into effect by no
means sufficiently or generally in Lunatic Asylums.
This has been abundantly manifest to us in our visits
of inspection. We shall endeavour to point out
to your Lordship the several advantages and defects of
these Institutions, in the particular to which we have
now adverted, and to show how far the arrangements
adopted in them answer to the requisite conditions of
a complete and proper system of classification.

The first object is the separation of dangerous Luna-
tics from others. Wherever a considerable number of

123

Lunatics are assembled, there are found some who are
subject to paroxysms of violent excitement, during
which they are apt to assault other patients, or any
persons within their reach. Others who are more
dangerous, suddenly and without any previous sign of
mischievous intention, inflict serious injuries, on slight
provocation, or without any apparent motive, or they are
prone to set fire to houses, and display various destruc-
tive and malicious propensities. These persons would
be sources of perpetual danger and alarm, and would
sometimes occasion serious calamities if they were left
at large in the midst of other patients, without being
carefully watched. It is desirable for the complete
security of the rest, to keep such dangerous persons, as
far as practicable, in one or more separate divisions,
where they may be surrounded by a sufficient number
of vigilant and experienced attendants. There is in
this particular a deficiency in many Lunatic Asylums
which we have visited.

In the second place, restless, noisy, and agitated Noisy Patients.
lunatics, who would annoy and irritate the more
tranquil, by shouting and screaming, require on this
account, separate wards and airing grounds, removed
as far as possible from the places appropriated to
patients of a different description. Where these
arrangements have not been adopted, which is the
case in many of the private and in some of the public
Asylums, the presence of noisy and turbulent maniacs
is a source of perpetual irritation to the quiet patients ;
and it must tend materially to aggravate their disorder,
and in many instances to retard or prevent their recovery.
We have particularly noticed the inconveniences arising
from the absence of adequate means for separating the
noisy from the tranquil patients, in our visits to the
public Asylums at Lincoln, Suffolk, and in the licensed
houses of Hoxton, Box, and Bailbrook House. The
defect now pointed out occasions great disquiet, and an

124

Dirty Patients.

Ill effects of
want of such
separation.

Melancholic

Patients especi-
ally affected.

Treatment of

Suicidal

Patients.

appearance of restless agitation through the whole of
those establishments.

A separate department is obviously required for that
class of patients, a very numerous one in many Lunatic
Asylums, whose state or conduct is such as to render
them disgusting and offensive to others. Fatuous per-
sons or those who have sunk into the last stage of
Dementia, and who are insensible to the calls of nature,
are of this description. In most of the Lunatic Asy-
lums of which the extent is sufficient to admit of an
adequate separation of patients from each other, atten-
tion has been paid to their comfort in this particular, but
we have in some instances had occasion to observe great
disquietude arising from the want of such an arrange-
ment, particularly at Lainston House, Bailbrook House,
and the private Asylums at Derby and Plympton. It
is right to state that the present proprietor of the
Derby Asylum, is about to discontinue the Pauper part
of his Establishment.

Melancholy or dejected patients often retain sufficient
power of observation and reflection to render them aware
of the state of others, and of their own condition, and they
contemplate with horror the prospect of being reduced
to the miserable plight of demented persons, or violent
maniacs, when they are associated with such patients as
they often are in Lunatic Asylums. On this accountmelan-
cholics suffer more than any other class of insane per-
sons from confinement in ill-regulated Establishments,
Patients labouring under Melancholia, on account of
the frequent instances of a suicidal tendency which are
known to occur among them, require greater vigilance
than any other description of persons. The classification
of these patients calls for much care and discrimination.
Their despondency would be aggravated if they were
placed in the same apartments with individuals whose
intellects are more deeply injured. They occasionally
derive benefit from the comparison and contrariety of

125

tlieir several illusions, and some melancholies are cheered
by being associated with patients of a lively and ex-
citable habit of mind. In the Lancaster Asylum, the
suicidal patients are associated with the cheerful, and
this arrangement appears to be judicious, and attended
with advantageous results. During an entire year, no
actual instance of self-destruction had occurred, though
there were upwards of a hundred cases in that Asylum
in which a suicidal tendency had been ascertained to
exist, and though no individual had been subjected to
personal restraint.*

There are many reasons which point out the impro- Separation of
priety of keeping persons subject to attacks of epilepsy in patients.
the same apartments with the other inmates. The
sudden paroxysms to which these patients are liable
are very distressing and alarming to timid persons, such
as are many of those who labour under the less severe
forms of insanity. On the other hand, the frequent
noises and causes of excitement which happen in wards
inhabited by maniacs, with whom epileptics are often
placed, are very injurious to the last-mentioned patients,
whose state requires that they should be kept free from
all disturbance and sources of irritation. In reference to
epileptic, and also to suicidal patients, an arrangement Arrangement
is adopted in the Lincoln Asylum, which we have ^ ?^^^ 1"^ ^°"

'■ •' ' com Asylum.

observed in no other institution, but which we think
deserving of imitation. These patients are placed in
dormitories, where they are constantly watched through-
out the night by an attendant, who sits up and is so
placed as to have a complete view of the apartments in
which the patients sleep.

Another class among the inmates of Lunatic Asylums

* It must be noted that four instances of suicide had occurred
during the preceding year within a short time, a fact which had been
attributed by the Superintendent, principally to the temptation and
opportunity occasioned by the existence of iron bars in the patients'
rooms.

126

Separation of are the tranquil and convalescent patients. In this
convalescent department all those persons may be placed who, though
patients. insane, are capable of conducting themselves quietly,

and occasion no annoyance to others.
Deviations from Deviations from the above method of separating

rule to 1)G deter"

mined by cir- patients, are occasionally introduced with advantage,
cumstances. ^y mixing individuals of one class with those of a
different description, when the particular state of such
patients is likely to be improved by that arrangement.
The propriety of such deviations from a general rule
must be determined by particular circumstances. It
will be seen that a somewhat mixed classification has
been adopted in the Lancaster Asylum.

We have not thought it necessary to specify aU the
instances in which we have found classification imper-
fect. These may in a great degree be collected from
the other parts of our Report, in which the excess of
restraint, and the defective construction of Asylums,
have formed the subjects of particular animadversion.
Classification in The method of classification adopted in the Lancaster
lum the most Asylum, is the most complete of any that has fallen
complete. under our observation. The outline of this is subjoined.

LANCASTER COUNTY ASYLUM.

clAkSSification and number op attendants before and since
the system of non-coercion was adopted.

On each side of the Establishment are ten Wards.

1. Cases of Dementia, associated with active, orderly,

and quiet cases, who have been some time in the
house, and are capable of rendering assistance to
the cases of Dementia.

2. Recent cases, associated with the orderly, active

and quiet cases of longer standing.

3. Patients who have not manifested a tendency to

violence, to the commission of suicide, or to escape
from the Establishment.

127

4. Convalescent cases, a few old cases, and one or two

suicidal cases.

5. Refractory and excited cases.

6. Suicidal cases, associated with cheerful and watchful

cases.

7. Refractory Patients, and violent Epileptics.

8. Epileptic Patients who are not violent.

9. Aged quiet cases, who have been a considerable

time in the Establishment, and a few suicidal
cases.
10. Infirmary.

The classification adopted in the Gloucester County Classification in
Asylum is on a more simple plan, and it seems to be Q^^^^^y ^gy.
productive of good efiects, since that establishment ^^^'
presents the appearance of comfort, tranquillity, and
good management. Excepting in what regards the
separation of epileptics — an arrangement, as we have
remarked, not firequently met with elsewhere — the system
of the Gloucester A§ylura may be considered as a fair
specimen of the classification adopted in County
Asylums. The patients are there distributed as follows :
one class consists of quiet patients and those approach-
ing to convalescence ; a second comprises the epileptics ;
a third, the fatuous patients; a fourth, the dirty and
noisy ; and a fifth, the working class, forming a distinct
body, which varies in number, and consists of the con-
valescents, and of some incurable patients, who, how-
ever, are capable of employment, and are occupied in
cultivating the garden and grounds.

128

IV.

OCCUPATION, AMUSEMENTS, AND EXERCISE.

Beneficial ef-
fects of occupa-
tions and
amusements.

By the Acts 2 & 3 Will. IV. c. 107, s. 37, and 5 & 6
Vict. c. 87, ss. 10^ 34, we are directed to inquire what
occupations and amusements are provided for Insane
Patients; and (by the latter Act) to state the eflfect
thereof, in-door and out-door respectively.

The answers which we have received to our inquiries
have been generally, that occupations and amusements,
especially such as take place in the open air, are beneficial
to the bodies as well as to the minds of the Patients.
Indeed, all intelligent persons who are well acquainted
with the disease of Lunacy, by having seen it in its dif-
ferent stages and varieties, and can therefore form some
opinion as to the chance of its relief or ultimate cure,
are strenuous in advising that insane patients should
be employed as much as possible. From the observa-
tions which we have been enabled to make on the
subject, in the course of our visits through the several
public and private Asylums of this country, we are
disposed to concur fully in this opinion. It appears to
us that employment should be afforded to all patients,
whether pauper or private ; and that they should be
induced to occupy themselves as much as is consistent
with their bodily health : not, however, with the view
of deriving any profit from their labour, but solely for
the purpose of relief or cure. There can be little doubt
but that by amusing the mind of a patient, and diverting
his attention from any idea, either painful or delusive,
which occupies it, that much good may be effected.
The longer a delusion is dwelt upon, the stronger and
more inveterate it becomes. It is important, therefore.

129

that it should be displaced (though only for a time)
as soon as possible, by a fresh and healthy train of
thought, and by occupations which may improve the
patient's bodily condition, with which his state of
mind is often connected, especially in the early stages
of insanity. Employment^ therefore, in cases of long
standing, tends to the tranquillity, and in recent cases
contributes materially to the recovery, of the patient.

In most instances, it is desirable to place at the
disposal of the patient, the same species of occupation
that he has been accustomed to follow, previously to
his entering the asylum ; and if he has not been
brought up to any profession or trade, it may be even
proper that he should be instructed in some regular
pursuit, in order fully to engage his attention. It is at
all times important, that as much exercise and employ-
ment as possible, in the open air, should be afforded, and
that for this purpose, gardening and agricultural labour
should be provided.

Without reference, however, to any pecuniary advan- Labour of
tage that may result to the rate-payer, or to the proprie- vf '^°v ^°i *"
tor of the Asylum, we deem it most necessary that em- as a source of
ployment should be provided for the lunatic. In fact, the
labour of a Patient neither can, nor ought to, be reckoned
upon as a regular source of profit. In the first place, it is
uncertain ; depending upon his health, temper, and dis-
position. A Lunatic, moreover, is a person afilicted with
a positive malady, which frequently circumscribes his
physical powers, and at other times exhibits itself in the
shape of dangerous or violent excitement, suspending for a
time, the capability of making himself useful. The object
of employing a patient is not that he should make a return
in value for the money expended upon him, but that
his tranquillity and comfort should be promoted, and
the disease with which he is afflicted, consequently
mitigated or even removed. For this purpose, moderate
labour only should be resorted to, and that as much as

130

Spacious yards
and pleasure
grounds should
be provided.

Music, dancing,
&c.

possible in the open air, in order to strengthen without
fatiguing the body; and it should be of such a nature
as will afford amusement, without any risk of harassing
the mind.

With a view to these objects, spacious and cheerful
vards, and also pleasure-grounds, should be provided, for
the purposes of exercise, and of yielding the patient
opportunities, at all seasonable times, of occupation and
amusement in keeping them in order. But as^ by these
means only, sufficient employment cannot at all times
be afforded to any considerable number of persons, it
seems necessary that a farm, or extensive gardens,
(proportioned to the number of patients), should be
attached to every large Asylum, and that a variety of
in-door employments should also be provided. In order
to promote exercise and occupation, it is also advisable
that some trifling indulgencies should be given to such
patients as are willing to perform a moderate quantity
of labour.

Music, dancing, and various games (as many as pos-
sible in the open air) may be resorted to with advantage,
in most cases, except where the patient is too exciteable.
No Asylum should be without a library. Books, ju-
diciously chosen, especially such as will not encourage
any morbid ideas already existing, are an important
help in promoting a happy and serene state of mind.
In cases of great depression, and particularly of religious
melancholy, books of a cheerful character should be
placed, to a much greater extent than is generally done,
at the disposal of the patients. In most of the Asylums
that we have visited, we have found an abundance of
religious publications, and in some few of them little
else. However useful such works may be, we have fre-
quently urged upon the various proprietors and super-
intendents, the duty of their also procuring books and
publications of an entertaining character, adapted to the
capacity of the patients under their care.

131

In the better-conducted Asylums, these views are Provisions for

• J 1 1 T-» 1 employment,

apparently acted upon to a considerable extent. Books &c. in better-
are procured and placed at the disposal of the patients ; conducted Asy-
the exercise of trades and other in-door employments
is encouraged, — in some cases rewarded ; and out-of-door
occupation is provided by means of large gardens or
farms, in which patients regularly labour in the proper
seasons.

In the Wakefield Lunatic Asylum, to which are In Wakefield
attached a garden of three acres, and a farm of forty
acres of land, we were informed (on our visit in Sep-
tember, 1842) that 120, out of 208, male patients, and
135, out of 190, female patients, were employed in various
ways. These patients belonged to a manufacturing
district, and occupied themselves in woollen and cotton
weaving, and all the clothes, including the shoes, used
throughout the establishment were made by the
inmates. They made fancy articles also for sale, and
performed all the gardening and agricultural labour. A
variety of amusements was provided for them, and the
effect both of occupation and amusement was considered
to be highly beneficial.

In the Kent Asylum, containing 253 patients, we Kent Asylum;
were informed (September, 1843) that about half the
patients of each sex were induced to work ; the men in
gardening and field-labour, and in cleaning the yards of
the establishment; the women in knitting, sewing,
washing, and household work. The land attached to
this Asylum consists of thirty-seven acres, fourteen of
which (laid out in gardens and airing-grounds) are
inclosed by walls.

In Dr. Warburton's Asylum, at Bethnal Green, Bethnal Green ;
a library of very considerable extent has been purchased,
from time to time, for the use of the patients, who are
also encouraged to employ themselves in various ways ;
some in making shoes, clothes, and mats; and others
K 2

132

Dorset County
Asylum ;

Gloucester

County Asy-
lum ;

Deficiency iu
respect of em-
ployment, &c.
in many Asy-
lums ;

West Auckland;

in the kitchen and laundry, and in needle and household
work, and in and about the yards of the Asylum.

In the Dorset County Asylum, (containing, in Octo-
ber, 1842, 109 pauper patients), a considerable propor-
tion are employed in the garden, laundry^ in plaiting
straw, and in needle and household work ; and they are
encouraged thus to occupy themselves by an extra diet.
A few books, and various amusements, are provided for
them ; and they are allowed to take exercise in the
neighbouring fields.

At the Gloucester County Asylum, besides the exten-
sive and cheerful yards and grounds in the midst of which
the buildings stand, there are twenty acres of garden
ground without the walls, which are entirely cultivated
by patients. On our visit to this establishment (in Sep-
tember, 1842), a number varying from sixteen to twenty-
six were thus employed, and a considerable proportion
of the other patients were occupied in various ways,
and always, according to the superintending physician's
report, with beneficial efi'ect.

But, in a considerable number of asylums, (not
excepting even some of the county asylums) there is a
great deficiency in respect to employment, and this
deprives the lunatic of his fair chance of that benefit
which these establishments were intended to afi"ord. It
appears to us that no means of cure or relief should be
left unattempted, in hospitals where the professed object
is to restore to health all who are still susceptible of
cure, and to relieve those who are incurable, as far as is
practicable. '

At the "West Auckland Asylum, there was at our first
visit only one, and there are now only two very small
yards, (each measuring about twelve yards wide by
thirteen yards long) for the thirty-one patients confined
there. There is, indeed, half an acre of garden ground,
and six acres of grass land, but these are available

133

only at certain seasons of the year for the purpose of
employing the male patients. Very little exertion
appears to be made at this asylum for the employment
of any of the patients. They were all, with the excep-
tion of one, unoccupied when we visited the place in
August, 1843. Vfe saw no books, and no means of
amusement.

At St. Peter's Hospital, in Bristol, the only place St. Peter's Hos-
where the female patients, forty in number, can take ' '

exercise, is a small passage or paved yard at one end of
the hospital. It is, in fact, part of a lane or road,
and is the only road through which carts and other
carriages have access to the house. Upon the approach
and return of every vehicle, the female patients are
removed into the House, in order that the gates at each
end of the road may be opened. It is right to state
that every exertion has been used to render the place
commodious, but this, from want of space, is quite im-
practicable.

At the Hilsea Asylum near Portsmouth, containing, Hilsea Asylum;
in June, 1843 twenty -nine patients, there is one yard of
tolerable size, for the male patients, adjoining the high
road, and a small one at the back of the house, which
appears, from its being overgrown with grass, to be
little used, for the women. We could not ascertain that
any of the patients occupied themselves, with the excep-
tion of two or three of the women, w^ho, we understood,
were occasionally employed in needle and household
work.

At the Leicester County Asylum, in which there were, Leicester
in August, 1842, 117 patients, there are only three J,"^?'^ ^'^'
acres used as garden ground and pasture, besides the
yards attached to the buildings, which last are inclosed
within high walls.

At the Nottingham County Asylum, in which there Nottingham

were, in Oct. 1842, 159 patients, there are good County Asy-
lum;

134

Norfolk County
Asylum ;

Haverfordwest
Asylum ;

yards ; but the premises are nearly surrounded by
adjacent buildings, and there are only a small garden
and three acres of land (rented) to afford employment
for the patients. Every endeavour, however, which the
space will allow, is made to occupy them.

At the Norfolk County Asylum, which contained,
in August, 1842, 165 patients, there are less than five
acres of ground, including the sites of the buildings.

At the Haverfordwest Asylum, in the county of
Pembroke, which contained eighteen patients (in
September, 1842) there was no place for exercise, except
two small yards, surrounded by walls ; and there was
neither garden, pleasure-ground, nor field, to afford any
opportunity whatsoever for the patients to employ them-
selves. There were no books, nor any means of amuse-
ment. The consequence was, that every patient in the
Asylum was listless and unoccupied. Most of these,
however, were apparently incurable.
Hoxton House ; At Hoxton House, containing nearly 400 patients, of
both sexes, there are only yards — some of them, indeed,
not deficient in space, but surrounded by high walls, and
(partly) by adjacent buildings, — for the purpose of
exercise. Being in the suburbs of London, there are
no means, of course, except at a very great expense,
of obtaining any considerable quantity of additional
ground.

The land immediately attached to the Lancaster
Asylum, where there were, in October, 1842, 621
patients, then, and until recently consisted, of five statute
acres, including the sites of the buildings and ofi&ces.
There were also ten acres (separated from the Asylum
by a public road), which are cultivated as a farm ; but
the entire quantity of land vcas quite inadequate to pro-
vide sufficient employment for so large a number of
patients, many of whom belong to the agricultural class.
This caused a considerable proportion of them to remain

Lancaster Asy^
lum;

135

unoccupied. * The superintendent, appears to use his
best endeavours to promote in-door employment^ in the
shape of plaiting straw, household work, and the exern
cise of various trades.

At the Asylum, called the Eefuge, near Hull, in which Refuge, near
there were (in September, 1842) 100 patients, there are ^"^^''
only yards of moderate dimensions for exercise. The pro- '
prietor has no land for agricultural purposes ; but there
is a garden of some extent, in which the patients (the
males and females alternately) take daily exercise, when
the weather will permit.

The Devonport "Workhouse, situate in the poorest Devonport
and most populous part of Devonport, with narrow Workhouse;
streets and high adjoining buildings on every side, is
licensed as an Asylum for lunatics. But there is only
a very small paved yard, in which the patients, amount-
ing to twenty-three, can take exercise. It is quite in-
sufficient for the purpose. The lunatic wards, however^
in this establishment, appeared to us to be under excellent
management.

At the Asylum at Duddeston (near Birmingham), ^s lum at Dud-
there are extensive grounds, but the pauper lunatics, deston ;
amounting to 60, (in January, 1844), are generally (if
not always) confined within very small yards, quite
insufficient for the purpose of exercise.

The Bailbrook Asylum, near Bath, is situate on an Bailbrook Asy-

eminence, but it is without the means of affiarding out- ^^'^•

of-door labour to the patients, amounting to 94 in

number, and almost all of the poorer class. — The yards

at Kingsdown Asylum, near Box, in Wiltshire,

where there is a large body of pauper lunatics, are

small and bad, and quite insufficient for the purpose of

exercise.

We have selected the foregoing instances, in order to General re-
marks.
* The County Magistrates, as has been elsewhere stated, have

lately added 30 acres to the Asylum, by purchase, under the powers
of a Local Act.

136

Insufficient pro-
vision for exer-
cise in Work-
houses.

show the nature of the defects inherent in several of the
Asylums; and in order also that previously to the
future erection of any establishments (especially public
Asylums), the subject may receive fair and full consi-
deration. We are fully satisfied of the great value of
occupation to the lunatic, and we think that no public
Asylum should be sanctioned without first ascertaining
that ample space exists, and that proper arrangements
will be made, for carrying this desirable object into
complete effect.

We have not here animadverted upon the small space
afforded to lunatics, for the purposes of exercise, in the
various Workhouses wherein they are confined. In the
Workhouse situate in the middle of the town of Bir-
mingham, there were, in September, 1843, seventy-one
insane patients of both sexes, and the only place allotted
to eighteen of the females, was a yard, common to them
and the other inmates of the Workhouse, in which they
were permitted to walk from ten till eleven o'clock in
the morning, and from three to four in the afternoon.
The remainder of the patients, fifty-three in number
(nearly thirty-three males and twenty females), took
exercise in a confined court or yard, not more than sixty -
six feet long by forty-five in width ; one corner (twenty-
three feet by twenty) being railed off for the females.
Both yards are surrounded by high buildings. In the
other unlicensed Workhouses which we have seen, the
space for exercise assigned to Insane poor, is generally
less in proportion to their numbers, even than in those
Licensed Houses to which we have adverted, as espe-
cially deficient in this respect.

137

RESTRAINT.

We are directed by the Act 5 & 6 Vic. c. 87, to inquire
in every Licensed House whether any patient is under
restraint, and why ; and to report whether there has been
adopted, either in the whole or in part, any system of
non-coercion, and the result thereof. By section 32, a
similar report is required to be made as to every county
Lunatic Asylum.

In every licensed house and county Lunatic Asylum,
and also in every public hospital, and other place con-
taining insane persons, which we have visited, we have
made minute inquiries as to the particulars of every
person found under restraint, and as to the system
adopted in the establishment in this respect.

In some Asylums, both public and private, the super- General remarks
intendents and proprietors state that they manage their jigugg of re-
patients without having recourse to any kind of re- straint.
straint whatever. In other Asylums, it is affirmed that
the disuse of restraint is their rule and system, and that
its use, in cases of necessity or expediency, forms the
exception to the rule. Those who profess the entire
disuse of restraint, employ manual force and seclusion
as parts of their method of management, maintaining
that such measures are consistent with a system of
non- restraint. It is said by these persons that when any
of the limbs (as the legs or hanils of a patient) are con-
fined by the strait -jacket, the belt, or by straps or
gloves, he is under restraint. But in cases where he is
held by the hands of attendants, or when he is for any
excitement or violence forced by manual strength into
a small chamber or cell, and left there, it is said that

138

restraint is not employed, and the method adopted
in these cases, is called " the non-restraint system."
In those cases where the patient is overpowered by
a number of keepers holding his hands or arms during
a paroxysm of violence, it is said that there is no
mechanical restraint. Here restraint of some sort or
other is manifest ; and even in those cases where the
patient is forced into a cell by manual strength, and
prevented from leaving it until his fit of excitement shall
have passed, it is difficult to understand how this also
can be reconciled with the profession of abstaining from
all restraint whatever, so as to be correctly termed ' Non-
restraint.' It seems to us that these measures are only
particular modes of restraint, the relative advantages of
which must depend altogether on the results. — The advo-
cates of these two systems, to which we have called your
Lordship's attention, appear to have been actuated by a
common desire to improve the condition of the insane.
Those who employ, as well as those who do not employ
mechanical restraint, adopt an equally mild and con-
ciliatory method of managing their Patients. The usual
forms of mechanical restraint are strong dresses, strait-
waistcoats, gloves, straps or belts made of linen-cloth or
leather.

The Retreat, at The Retreat, at York, was established in the year
York

1796, and introduced a milder system of managing the

insane, than any then previously practised. This ad-
mirable institution has from its foundation up to the pre-
sent time steadily pursued the same humane and bene-
volent method of treating its patients with which it
commenced, and Mr. Samuel Tuke, so well known in
connexion with this Asylum, and who accompanied us
iu going over it, said that no considerable change in
regard to the system in use at the Retreat had re-
cently taken place.
Attention of lu the year 1828, the licensing and visiting of Houses

Commissioners ^^j. ^j^^ reception of the Insane in the Metropolitan dis-

directed to abo- -"^ -^

139

trict was entrusted to this Commission; and we have since lition of le-
that period constantly directed our attention to procure *''^'°'-
the abolition of restraint, in all cases in which we have
considered that its use could be avoided with benefit,
and without danger, and to its modification and dimi-
nution in those cases in which we have thought it to
be still necessary.

Whatever may be the means or forms of control Bodily restraint
exercised over the persons of patients, or whatever the ?°^ permitted

*^ jT 7 m well-managed

degrees in which the application of this control may be Asylums, except

111 6Xtl*6rDC

varied in different Asylums, we have the gratification cases.
of reporting to your Lordship that in every public and
private Asylum in the kingdom, which is well managed,
bodily restraint is not permitted, except in extreme
cases, and under the express sanction of a competent
superintendent. The unanimous opinion of the medi-
cal officers and superintendents of these public and
private Asylums is, that the diminution of restraint
in the treatment of lunatics has not only lessened the
sufferings, but has improved the general health and
condition, as well as promoted the comfort of the
insane. "We entirely concur in this opinion.

Before noticing the distinctions that we have found Censurable

in the different public and well-conducted Asylums, ^f^t^aint prac-
tised in certain
upon the subject of restraint, we feel it to be our duty Asylums.

to direct your attention to that excessive and highly
censurable degree of restraint, which we found in prac-
tice at the licensed Asylums at West Auckland,
Wreckenton, Lainston, Plympton, Box, Nunkeeling,
and some other houses which we have elsewhere
made the subject of especial notice. In the present
state of some of these establishments, restraint is ren-
dered more necessary than in a well-constructed Asylum,
but all such places are, in our opinion, unfit for the
proper care of the insane. With respect to th ese Asylums,
in which the restraint in use has been so improper and
unjustifiable, we hope that the day is not distant when

140

they will either wholly cease to be licensed for the recep-
tion of insane persons, or will be put upon an entirely
improved system in this and in other respects.
Results of the The non-restraint system* appears to have been esta-
system. blished at Lincoln in 1838, and to have been adopted at

Han well in 1839, and at Lancaster in 1840. The
same system has been in operation for some years in
the Suffolk Asylum, and is now in practice at Glou-
cester, and has been pursued at Northampton from its
opening in 1838 ; and at the Haslar Hospital it had
been in operation fifteen months at our visit in 1843.
The superintendents of these Asylums have all steadily
pursued this system since its introduction, and, as they
consider, with great advantage to their patients ; but
they still think that it is necessary to restrain the
limbs during surgical operations. We found the Asylums
at Gloucester, Lancaster, Northampton, and Haslar,
very well managed, and their patients tranquil and
comfortable and the superintendents of these Esta-
blishments, consider that the comfort of the patients,
and the general condition of the Asylums, have
been improved since the adoption of this system. No
inconveniences whatever have been experienced at
Gloucester or Northampton. In the year ending the
30th of June, 1842, there were four deaths by suicide at
the Lancaster Asylum. The superintendent of this Asy-
lum has stated that had mechanical restraint been in prac-
tice in the Asylum, it would not have been resorted to
in any of these cases, and that these lamentable events
are not fairly to be attributed to the absence of such
restraint. The present Medical Officers at the Lancaster
Asylum have carried out the system of non-restramt to
its fullest extent. By every expression of kindness,
by appearing to sympathise in the patient's imaginary

* By the non-restraint system is understood the system which does not
employ restraint, by dresses, gloves, belts, or other similar coDtrivances.

141

sufferings, and by taking a deep interest in all his con-
cerns, they endeavour to soothe morbid irritation, and
thus allow an opportunity of restoring the healthy
action of the mind. By this method, in several
recent cases the Superintendent has been successful
in curing the disease, or at all events in preparing the
frame for the reception, and favourable operation of
medicines, and other means calculated to promote a
cure. We found unusual excitement prevailing in the
disorderly ward on the female side of the Asylum at
Lincoln ; and in one of our visits to Hanwell and at
both our visits to the Suffolk Asylum, we witnessed,
amongst the worst class of females, outbreaks of violence
and excitement, which we have not met with elsewhere.
At the Lincoln Asylum, a register of accidents and
bruises, &c., is kept, which seem frequent.

The system of non-restraint at Hanwell has been System at Han-
carried on by mild and kind treatment of the patients,
by an increase in the numbers of attendants, and by
adopting seclusion or solitary confinement, sometimes in
darkened cells, in lieu of mechanical restraint. At
our visit to this Asylum in 1843, there was no patient
under mechanical restraint ; but we saw a violent female
lunatic, who had been endeavouring to bite other persons
as well as herself, seized by four or five of the nurses,
and after a violent and protracted struggle, forced with
great difficulty into, and fastened in, one of the cells.
During this scene, there was much confusion in the ward,
and the great efforts of the patient to liberate herself,
and (after her seclusion) the violence with which she
struck the door of the cell, and threw herself against it,
must have greatly exhausted her. In another case, a fe-
male, secluded in a darkened cell, had contrived to tear
off considerable quantities of a woollen rug, which she
formed into balls and swallowed ; one of these stuck in
her throat, and, but for prompt assistance, accidentally
rendered at our visit, she might have been suffocated.

142

In another case, a female patient rushed against an elderly-
female with all her weight, striking her at the same
time violently on the loins, and precipitating her for-
wards. The person thus struck, being quite unaware of
the attack, fell forwards on her head and neck in such
a way as to cause apprehension lest a dislocation of
the neck might have taken place ; fortunately she did
not receive any serious damage. Another woman was
seen by us with the skin of her arm torn nearly from
the wrist to the elbow, and bleeding from a severe cut
which she had just received, by thrusting it through the
window of the cell in which she was confined. Besides
these acts of violence, we observed on the bodies of
several other patients various cuts and bruises, which
we were told had been inflicted by their insane com-
panions, and which we rarely meet with in other
Asylums. During the short interval between the first
and last days of our visit to this Asylum in June,
1843, one of the male patients was killed by another.—
On our visit to HanweU in the year 1844, we found
the Asylum in good order, and the patients, with one
or two exceptions, tranquil and comfortable ; and not
one under mechanical restraint.
The Suffolk In the Suffolk Asylum, the patients, with the excep-

^ "™' tion of those of the worst class of females, were tranquil.

At our first visit, however, in the ward occupied by
refractory females, and in the airing-court attached to it,
there were a great number of violently-excited patients,
who attacked^ abused, and struck at the other patients,
and rendered the whole place a scene of distressing
turbulence and confusion. At our second visit, the
matron expressed a fear of the consequences, in the
event of our going into the female refractory yard.
"We found some of the Patients half naked, from
having destroyed their clothes; one was, during the
whole time we were in the yard, struggling with a
nurse : two of the most violent were removed from

143

the yard before we entered it, and the fury of those
who remained was excessive.

We do not offer any opinion as to whether the acts
of excitement and violence which we met with in the
Lincoln, HanweU, and Suffolk Asylums, were the result
of mechanical restraint being dispensed with. It is to be
observed, that at the Lincoln and Suffolk Asylums, there
is a great want of proper classification, to which the
scenes which we witnessed were no doubt partly to be
attributed.

With respect to the public Hospitals and County
Asylums which still occasionally employ mechanical re-
straint, we found the following numbers of persons under
such restraint at the periods of our visits.

PUBLIC HOSPITALS AND COUNTY ASYLUMS USING
MECHANICAL RESTRAINT.

Want of classi-
fication may-
lead to excite-
ment and vio-
lence.

Hospitals.

•s-Sg

Hospitals.

3 3 m

Retreat, at York .
York Asylum
St. Luke's . .

99
159
222

1
1

Radcliffe . . ,
Liverpool . . .
Exeter ....

42
73

1
1

Tabular view of
numbers under
restraint at
Commissioners'
visits 'to Public
and County
Asylums.

County Asylums.

lei

County Asylums.

§=3

Bedford ....

140

Nottingham . ,

159

Cbester ....

157

Norfolk ....

164

Cornwall . . .

147

Stafford ....

244

Dorset ....

105

Surrey ....

344

Kent ....

253

Wakefield . . .

3,98

Leicester . . .

114

At the Retreat, at York, at our first visit, one female Case of restraint
was under restraint. She was sitting at table dining ^ *^® ^^*'^^^*»
with the other patients, and had only one hand confined.
Another patient was secluded in a room. At our second
visit, no one was under mechanical restraint, and there
had been no one so restrained for nine months. We

144

System of Re-
straint at York
Asylum, &c.

Practice pur-
sued in County
Asylums.

Restraint in Li-
censed Houses.

found the patients in the Retreat tranquil, cheerful,
and clean, and apparently enjoying every comfort of
which they were capable.

The York Asylum, the Hospital of St. Luke, the
Radcliffe (now the Warneford) Asylum), and the
Asylums at Liverpool and Exeter, have for many years
pursued a mUd system of treatment, and have not re-
sorted to restraint except in cases of emergency, and
under medical authority. Some of these Hospitals are
more commodious and have better accommodations and
conveniences than others, but in all of them we found
the patients kindly and judiciously treated, and, as far
as their circumstances would admit, comfortable.

In the County Asylums, in which mechanical restraint
is still occasionally resorted to, the system pursued is
that of dispensing with it in every case, unless either
the cure, or the security of the patient, or others, is con-
sidered to render it necessary. The single patient found
under restraint at the Chester Asylum was a most
violent and dangerous maniac, who had been convicted
of murder, and would, if at liberty, instantly attack any
person near him, in the most savage manner. The
only person under restraint at the Kent Asylum, in which
was a large proportion of most violent female patients
was a powerful and dangerous man, who is disposed to
strike and injure the othar patients, and especially those
who are not so strong as himself. At the Nottingham
Asylum, when visited in 1843, no restraint had been used
during the previous year, except in four cases, for surgical
purposes. We have in general found the patients confined
in these Asylums tranquil and comfortable. At the
Wakefield Asylum there were ten patients under re-
straint. This may be considered a large number : this
Asylum, however, is in general very well conducted.

We feel that it is more difBicult for us to convey to
your Lordship an accurate view of the state of licensed
houses, than of public Hospitals and County Asylums

145

in respect to the subject of restraint. There are ninety-
nine licensed houses in the provincial districts, of which
thirty-nine receive paupers ; and forty-three licensed
houses in the Metropolitan district, of which four
admit paupers. At the licensed houses at Denham-
Park and Fairford, restraint is stated not to be employed,
under any circumstances ; and these houses are both well
managed. We were, however, sorry to see a female, in
1843, at Fairford, permitted to gnaw her fingers into
sores. The proprietors of almost all the best-managed
Asylums for private patients, in the provincial and
Metropolitan districts, employ restraint only in extreme
cases. Although we believe that the two houses above-
mentioned, are nearly the only Licensed Houses in
which mechanical restraint is entirely suppressed, yet
out of 60 Houses receiving only Private Patients in the
Provincial Districts, we found, in 37 that there was
not one person, and in 15 only one person in each, under
restraint. In the Metropolitan District at our last visit
in the year 1843, out of 32 houses receiving only Private
Patients, in 22 there was not one, and in 6 we found only
one under restraint. At the White and Red Houses of
Dr. Warburton, at Bethnal Green (the one for males and
the other for females) there are 575 patients, the larger
part of whom are paupers, and many of the females are
of the worst and most hopeless and violent class. In
these houses, we seldom find more than one or two
persons under bodily restraint, and in four out of our
last eight visits, not one. At Hoxton, containing
upwards of 400 patients, there are frequently eight or
ten persons restrained : but in the present defective
accommodations of this house more restraint is
employed than would be necessary in a well- con-
structed Asylum.
Those who profess wholly, and those who profess in Seclusion or

, . , ,. .,, 1. • i 1 1 • solitary confine-

part Only, to dispense with restraint, employ seclusion or ^^^^'

solitary confinement ; but the former resort to and advo-

146

cate this mode of treatment more extensively than the
latter. Seclusion or solitary confinement is now getting
into general use in the treatment of the insane, and
great numbers of the superintendents of public, and of the
proprietors of private Asylums throughout the country
are fitting up and bringing into use solitary cells, and
padded rooms for violent and unmanageable Lunatics.
Lincoln Asylum is the only place in which even seclu-
sion is not resorted to. Seclusion (or solitary confine-
ment) is found to have a very powerful efifect in tran-
quillising, and subduing those who are under temporary
excitement or paroxysms of violent insanity. As
solitary confinement is coming into more general use,
as a remedy in Asylums, and as persons who have
been subjected to its operation for long periods, have
become insane, we feel that we ought to notice the prac-
tice so far as it may be employed in the treatment of
lunatics. As a temporary remedy, for very short periodS;;
in cases of paroxysms and of high excitement, we believe
seclusion to be a valuable remedy. We are convinced,
however, that it ought to be used only for short periods,
and that it should not be permitted as a means of
managing and treating those persons who are perma-
nently violent and dangerous. Long solitary confine-
ment of any person in a cell, is calculated to destroy his
bodily health.
Register should If Solitary confinement is to be employed in Asylums,
soliirycTnfire- ^^^^7 institution, whether public or private, which
meat employed, ^ges it, should be required to keep a register of every
person who shall be in such confinement, and of the
duration of every separate term of confinement. If it
has been deemed necessary by the legislature to require a
register of restraint, it is equally necessary, in our
opinion, to have a register of seclusion or solitary confine-
ment, which is more liable to abuse, and less capable
of detection, than those means of bodily coercion,
which are visible, and are in ordinary use. At Hanwell

147

this precaution has been wisely adopted, and was found
in practice at our last visit, being required by the printed
rules of the Asylum. It is obvious that seclusion, or
confinement, with the limbs all at liberty, is not a pro-
tection against the indulgence of certain dirty and dis- Dirty habits.
gusting practices, which are very injurious and not un-
common, but very difficult to overcome in the insane.
Mechanical restraint has succeeded in some, but by no
means in all cases, in removing them. At the Middlesex
Asylum, it has been attempted to defeat dirty habits
by the administering of aperients. At the Lancaster
Asylum, good effects have been produced in obviating,
and in many cases in entirely removing, such habits,
by assiduously endeavouring to invite due attention to
the calls of nature^

With a view to lessen the necessity for bodily coer- Means
cion, we have enjoined, in the Metropolitan district, the ^ploy^d m
division of patients into classes, and the separation of district to ob-

,1 1 1 i ., , -i J. J viate restraint.

those, whose habits or temporary excitement render
them dangerous, from others who are irioffensive; we
have also urged an increase of attendants on the former
classes. We have further recommended the erection
of separate rooms for the temporary seclusion, during
short periods only, of those who are subject to
paroxysms of excitement or violence.

In the month of July last, we found, at Whitmore Danger of total
House, a gentleman sitting in a room with a number '.^"f^ ° mecha-

' ° o nicai restraint,

of other patients, who had a short time previous illustrated by
bitten the hand of one of the attendants, so as to cause
serious apprehensions that it would have been necessary
to amputate the arm. This patient had been secluded
in a padded room some portion of the day on which we
saw him, and at the time of our visit was unre-
strained, but under the watch of two keepers, who
were in the apartment for that purpose. The medical
superintendent and keeper both stated that notwith-
standing the precautions then in use, they were appre-
l2

148

hensive of a similar injury being inflicted by him upon
some other patient or attendant ; but in deference to
the popular opinion on the subject, they did not apply
mechanical restraint, although they thought that it was
necessary. We recommended that bodily restraint should
be employed. Shortly after giving this recommendation,
we found at the Asylum of Mr. Scales, near Portsmouth,
the widow of a former superintendent, whose hand had
a few months previous been bitten by a dangerous
patient, who was in the house at the time of our visit.
The superintendent died from the effects of the bite,
within twelve days after the injury. In the County
Asylum, at Bodmin, we found two patients, one of
whom had lost an arm, and another a thumb from
amputation, in consequence of the bites of other patients.

In the Asylum for the county of Dorset, we found a
patient whose suicidal propensities were so determined
that he had once attempted to drown himself, twice to
hang himself, once to cut his throat, and also to choke
himself by thrusting his sheets down his throat, and to
strangle himself by twisting his handkerchief round his
neck. The restraint of muffs was resorted to ; and, al-
though previously restless and trying continually to get
out of bed, this person began to sleep comfortably, and
was, when we saw him, tranquil and apparently con-
valescent. Restraint had only been used in six cases in
this Asylum during twelve months. The particulars
of four of these cases are unfit for publication. Of
these six cases, three had been discharged cured, and
another was recovering.

At Great Foster House, near Egham, a gentleman had
been brought to the house in a state of violent excitement.
For seven successive nights he had no bodily restraint,
but had two attendants in his bed room, and neither he
nor they had had any sleep. He was continually get-
ting out of bed and struggling with the attendants. The
attempt to do without bodily restraint had been carried

149

to this extent, in some degree, in deference to the popular
opinion, but it was then thought right not to continue
it any longer ; and on the eighth night muflFs were put on
the patient, and he soon after fell asleep, and slept
throughout the night. On the next night, he recom-
menced his violence, but the muffs being produced, he
became tranquil and went to sleep, without its being
necessary to put them on. This gentleman was dis-
charged much improved, but not cured. The super-
intendent stated his opinion to be, that the struggling
with the attendants irritated, but the application of the
muffs tranquillized the patient.

The proprietor of the Asylum at Fish Ponds, near
Bristol, stated that he believed that a patient in his
house recovered entirely owing to his having bodily
restraint. He had been previously watched by attendants.
and was very much excited by it; when put under such
restraint he fell asleep and gradually became tranquil. —
The same good effect was produced, at Mr. Taylor's
Asylum, near Bristol, on a female Patient, who was
exceedingly irritated at being watched, but became
quiet when placed under some slight mechanical restraint.
— At Moorcroft House, Hillingdon, a patient was con-
tinually striking himself with great violence, and we
were informed would have produced serious, if not fatal
injuries, unless he had been restrained. — In the Bethnal
Green Asylum, a male patient, with dangerous propen-
sities, was allowed to go unrestrained, and during this
period assaulted a keeper, and kicked him so violently
in the abdomen, that an abscess ensued, and the keeper
was for some time in danger of losing his life. — At
Northumberland House Asylum, a powerful maniac, one
of whose hands it is now considered advisable to restrain
by a strap, was permitted to go at large, during which
period he struck the pointed end of a pair of snuffers into
a keeper's head, and endangered his life. — We have, at
different times, received numerous assurances that the

150

Remarks on the
practice of re-
straint.

Additional ex-
pense for Pau-
pers in Private
Asylums, if
restraint dis-
pensed with.

Safety of attend-
ants endangered
by absence of
restraint.

use of mild mechanical restraint has had the eflfect of
making the Patients tranquil and comfortable.

It is possible, that cases such as those which we
have instanced, may be managed without mechanical
restraint. The question, however, in which the humane
and intelligent medical practitioner is interested, is
not whether it be possible, but whether it be prefer-
able, in all cases, to dispense with such restraint alto-
gether, and to substitute, in its stead, manual coercion
and solitary confinement. It is necessary to observe,
that a system of management which may be eligible
under some circumstances, may not be equally so under
others. That which may be practicable in large Asylums,
may not be feasible in smaller Establishments. These
and other circumstances must be taken into consideration,
in estimating the practicability of adopting or rejecting
a system, entirely interdicting the use of mechanical
restraint. In Private Asylums which receive paupers,
if it be desired that the Visitors shall requu-e an entire
absence of mechanical restraint, the public must be pre-
pared to pay an additional sum for their care and main-
tenance of the patients, otherwise they must either suffer
long-continued solitary seclusion, which will destroy
their health, or the attendants and other patients will
be exposed to constant peril.

Attention to the safety and comfort of Attendants is
a very important part of the duty of the proprietors of
Asylums for the insane. It is a great object to
secure the services of respectable and superior persons
as attendants and nurses ; but if such persons are to
be induced to take charge of the insane, it is necessary
to assure them that they are not to lead a life of cease-
less anxiety and to be in continual apprehension of vio-
lence.

On visiting the Asylum of Mr. Phillips, at De-
vizes, we found that there were 153 patients in the
House, and that one woman only was restrained, who

151

had just been quarrelling with some other patients, In
the yard where she was, and which contained the worst
class of females, there were more than twenty most
violent and dangerous women, who, but for the presence
of two experienced and very clever nurses, would pro-
bably have injured each other. Whilst we were taking
down the names of the patients, in one of the men's
yards, aq athletic male Patient suddenly came up and
struck the resident medical attendant a blow on the
head, with all his force. Another keeper was sent
for, and, with our sanction, a strap was put round
the man's body, and one of his hands was fastened
to it.

Within the last few weeks, at Dr. Philp's House, at
Kensington, the male patients had all been taken out to
walk in the garden. A very powerful and dangerous
male patient asked permission of the attendant to go into
the house, to the closet. In a minute or two, shrieks
were heard, and upon the servants rushing into the
house, they found that he had seen the matron at a
window, (who, in the absence of the patients, had gone
to look over the men's rooms,) had attacked her in the
most savage manner, and had knocked out seven of her
teeth, and otherwise severely injured her. Her life
was for some time afterwards in imminent danger.

To these must be added the cases, already men-
tioned, of the superintendent at Hilsea, and of the
attendants at Whitmore House and Bethnal Green.

The mild system now adopted in all the county Asy- Additional
lums which do not profess to do entirely without attendants and
restraint, has required the employment of an increased nurses required

by adoption of

number of attendants and nurses. In some of these xaili system.
Establishments, it is considered that, although the com-
fort of the patients has been promoted, the attendants
have been subjected to greater risks, by the diminution
of restraint. In order, however, to carry into effect,
with perfect safety to the patients and attendants, a

152

system of entire abstinence from bodily or mechanical
restraint, there ought to be a greater number of yards than
some Asylums, such as those of Lincoln, Suflfolk, and
Hanwell, possess, in proportion to the numbers of their
patients. In Hanwell, for instance, the yards, which
are of triangular shape, are comparatively small, mea-
suring about 195 feet at the sides, and 120 at the base.
One of these yards is open to two wards containing 90,
another to four wards containing 197, and a third to
five wards containing 124 patients. If, instead of only
30, there were a large number of curable and recent
cases in this Asylum, we think that, with the present
accommodations, even more attendants than are now
employed would be absolutely necessary. Any addi-
tional yards must be attended with some increase of
expense ; but if the entire disuse of mechanical restraint,
and the substitution of solitary confinement, be more
humane towards the insane, and more conducive to their
cure, than the use of such restraint, the increase of
expense will assuredly not be considered a sufficient
justification for its continuance. Magistrates, however,
before they decide upon adopting a system of managing
their pauper lunatics, which will necessarily impose
a considerable additional expense upon parishes and
counties, will, of course, previously satisfy themselves
that the advantages to be derived from it are real
and sufficient to justify the additional cost.
Opinions of During our visits to the dififerent Asylums, we have

int^en'dents of"* endeavoured to ascertain the opinions of their Medical
Asylums on Superintendents in reference to the subject of restraint ;
and we will now state, in general terms, the result of
our inquiries. Of the Superintendents of Asylums
not employing mechanical restraint, those of the Hos-
pitals of Lincoln, Northampton, and Haslar, and of
the County Asylum at Hanwell, appear to consider
that it is not necessary or advisable to resort to
it in any case whatever, except for surgical pur-

153

poses. On the other hand, the Superintendent at Lan-
caster hesitates in giving an opinion decidedly in
favour of the non- restraint system : he thinks that
although much may be done without mechanical re-
straint of any kind, there are occasionally cases in which
it may not only be necessary, but beneficial. The Su-
perintendent of the Sufiblk Asylum considers that in
certain cases, and more especially in a crowded and im-
perfectly constructed Asylum, like the one under his
charge, mechanical restraint, judiciously applied, might
be preferable to any other species of coercion, as being
both less irritating and more efiectual. — The Superin-
tendent of the Gloucester Asylum states that he has
adopted the disuse of mechanical restraint, upon the
conviction which his experience has given him during
a trial of nearly three years. — Of the Superin-
tendents of Asylums who employ mechanical re-
straint, those of the Retreat at York, of the Warne-
ford Asylum, and of the Hospitals at Exeter,
Manchester, Liverpool, and of St. Luke's, consider
that although the cases are extremely rare in which
mechanical restraint should be applied, it is, in some in-
stances, necessary. Similar opinions are entertained by
the Superintendents of the County Asylums of Bedford,
Chester, Cornwall, Dorset, Kent, Norfolk, Nottingham,
Leicester, Stafibrd, and the West Riding of York. —
At the Retreat at York, mechanical or personal restraint
has been always regarded as a " necessary evil," but it
has not been thought right to dispense with the use of a
mild and protecting personal restraint, believing that,
independent of all consideration for the safety of the
attendants, and of the Patients themselves, it may in
many cases be regarded as the least irritating, and there-
fore the kindest method of control. Eight of the
Superintendents employing bodily restraint have stated
their opinion to be that it is in some cases beneficial as

154

well as necessary, and valuable as a precaution, and a

remedial agent; and three of them have stated that

they consider it less irritating than holding with the

hands, and one of them prefers it to seclusion.

Practice in In all the Houses receiving only private Patients,

Houses receiv- .... • i i j i • n t

ing only Private ^Gstramt IS considered to be occasionally necessary. In
Patients. ^j^g large and very well conducted Houses, where the

Proprietors are persons of great experience, and where
they have every means of separating and managing their
Patients, and have large numbers of attendants and
nurses, the application of restraint is considered at times
not only necessary, but beneficial to the Patient. In
several instances, Patients have been named to us who,
apprehensive of their attacks coming on, have
requested to be restrained for their own security. At
the Cornwall Asylum, we found a man who volun-
tarily wrapped his arm round Avith bands of cloth from
the fear of striking others. He untied the cloth himself
at our request. We know the case of one lady, who goes
home when she is convalescent, but voluntarily returns
to the Asylum, when she perceives that her periodical
attacks of Insanity are about to return, in order that
she may be placed under some restraint.

We have thus endeavoured to state with accuracy the
difference between the methods of treatment adopted
by those who wholly disuse, and those who occa-
sionally employ mechanical restraint ; the condition in
which we have found the Public Hospitals, County
Asylums, and Licensed Houses which are conducted
according to these systems; and lastly, the opinions
which have been expressed to us by the Medical
Superintendents of these Institutions, as to the employ-
ment or disuse of mechanical restraint. We have
explained to your Lordship that, in our visitations
to Lunatic Asylums, we have witnessed, without
remonstrance, such measures of mechanical restraint

155

as, in the opinion of the Superintendents, sufficed to
prevent dangerous or disgusting propensities, when
assured that it was deemed necessary in the one case
and expedient in the other; and that we have, in
more than one instance, recommended the application of
some mechanical restraint in cases of extreme violence,
when the Medical Superintendent has told us that he
scrupled to use it, out of deference to what he con-
sidered to be the public opinion upon the subject,
although he thought it necessary.

Of the Asylums entirely disusing restraint, in some
of them, as we have stated, the patients have been found
tranquil and comfortable, and in others they have been
unusually excited and disturbed. Without, however,
attaching undue importance to the condition of the
Asylums at the time of our visits, or to accidents
that may happen under any system of managing the
Insane, it is nevertheless our duty to call your Lord-
ship's attention to the fact, that since the Autumn of
1842 a Patient and a Superintendent have been killed ;
a Matron has been so seriously injured that her life
was considered to be in imminent danger ; another
Superintendent has been so bitten as to cause serious
apprehensions that his arm must have been amputated ;
and two keepers have been injured so as to endanger
their lives. These fatal and serious injuries and acci-
dents have been caused by dangerous patients, and
some of them in Asylums where either the system of
non-coercion is voluntarily practised, or is adopted in
deference to public opinion.

Haying stated, in general terms, the opinions pre-
vailing in the principal Asylums, for and against the
system of absolute non-coercion ; it may be desirable,
with the view of enabling your Lordship to judge more
accurately of the value of each, to add the reasons (as
far as we have been able to collect them) which the

156

Arguments of
Medical Officers
and Super-
intendents advo-
cating absolute
non-coercion.

several advocates adduce, for adopting or continuing
their respective modes of managing or controlling the
Insane.

The Medical Officers and Superintendents who ad-
here to the system of absolute non-coercion, never
using mechanical restraint, even in cases of extreme
violence, argue —

1st. That their practice is the most humane, and most
beneficial to the Patient ; soothing instead of coercing
him during irritation ; and encouraging him when tran-
quil, to exert his faculties, in order to acquire complete
self-control.

2. That a recovery thus obtained, is likely to be more
permanent than if obtained by other means ; and that
in case of a tendency to relapse, the Patient will, of his
own accordj be more likely to endeavour to resist any
return of his malady.

3. That mechanical restraint has a bad moral effect
that it degrades the Patient in his own opinion ; that it
prevents any exertion on his part ; and thus impedes his
recovery.

4. That experience has demonstrated the advantage
of entirely abolishing restraint, inasmuch as the condi-
tion of some Asylums, where it had been previously
practised in a moderate and very restricted degree, has
been greatly improved, with respect to the tranquillity
and the appearance of cheerfulness among the Patients
in general, after all mechanical coercion has been dis-
continued.

5. That mechanical restraint, if used at all, is liable to
great abuse from Keepers and Nurses, who will often
resort to it for the sake of avoiding trouble to them-
selves ; and who, even when well-disposed towards the
Patient, are not competent to judge of the extent to
which it ought to be applied.

6. That the Patient may be controlled as effectually

157

without mechanical restraint, as with it ; and that the
only requisites for enabling the Superintendents of
Asylums to dispense with the use of mechanical restraint,
are a greater number of Attendants, and a better system
of classification amongst the Patients; and that the
additional expense thereby incurred ought not to form
a consideration where the comfort of the Patients is
concerned.

On the other hand, the Medical and other Superin- Arguments of

jMcdicSil Officers
tendents of Lunatic Asylums, who adopt a system of ^nd Super-
non-restraint as a general rule, but make exceptions in mtendents who

° ' ^ admit restraint

certain extreme cases, — urge the following reasons for in extreme
occasionally using some slight coercion. They affirm —

1st. That it is necessary to possess, and to acquire as
soon as possible, a certain degree of authority or influence
over the Patient ; in order to enforce obedience to
such salutar}' regulations as may be laid down for his
benefit.

2. That, although this authority or influence is obtained
in a majority of cases by kindness and persuasion, there
are frequent instances where these means entirely fail.
That it then becomes necessary to have recourse to other
measures, and, at all events, to show the Patient that, in
default of his compliance, it is in the power of the Super-
intendent to employ coercion.

3. That a judicious employment of authority mixed
with kindness (and sometimes with indulgence) has been
found to succeed better than any other method.

4. That the occasional use of slight mechanical re-
straint has, in many instances, been found to promote
tranquillity by day, and rest by night.

5. That,, it prevents, more surely than any supervision
can efi'ect, the Patient from injuring himself or the other
Patients.

6. That, particularly in large Establishments, the
supervision must be trusted mainly to the attendants,
who are not always to be depended on, and whose pa-

158

tience, in cases of protracted violence, is frequently
worn out. That in such cases mild restraint ensures
more completely the safety of the attendants, and con-
tributes much to the tranquillity and comfort of the
surrounding patients.

7. That in many cases mild mechanical restraint tends
less to irritate, and generally less to exhaust the Patient,
than the act of detaining him by manual strength, or
forcing him into a place of seclusion, and leaving him
at liberty to throw himself violently about for hours
together.

8. That the expense of a number of attendants, — not
indeed more than sufficient to restrain a Patient during
a violent paroxysm, but nevertheless far beyond the
ordinary exigencies of the Establishment, — is impracti-
cable in Asylums where only a small number of Pau-
pers are received.

9. That the occasional use of slight coercion, parti-
cularly in protracted cases, possesses this additional
advantage ; that it gives the Patient the opportunity of
taking exercise in the open air, at times when, but for
the use of it, he would necessarily be in a state of
seclusion.

10. That the system of non-restraint cannot be safely
carried into execution without considerable additional
expense ; a matter which will necessarily enter into the
consideration of those who are desirous of forming a
correct opinion as to the precise benefits likely to arise
from the adoption or rejection of such a system.

11. That the benefit to the Patient himself, if indeed
it exist at all, is not the only question ; but that it
ought to be considered, whether the doubtful advantage
to himself ought to be purchased by the danger to
which both he and his attendants and other Patients
are exposed, when restraint is altogether abolished.

And 12thly. That, when a Patient is forced into and
secluded in a small room or cell, it is essentially coer-

159

cion, in another form and under another name ; and
that it is attended with quite as bad a moral effect, as
any that can arise from mechanical restraint.

VI.

RELIGIOUS SERVICES.

In respect to Devotional Exercises, and Religious Proper atten-
Instruction, we have the satisfaction of reporting- to p^i^j fo religious
your Lordship, that proper attention appears to be very observances.
generally paid by the Proprietors and Superintendents
of Asylums to these important duties ; that the service
of the Church is, for the most part, regularly performed
every Sunday ; and that Prayers are, in many cases, read
on other days of the week, where there are Patients in a
condition to benefit by them. We may state also, as
the result of our inquiries, that the effect is tranquillizing,
and productive of good order and decorum, in a remark-
able degree, and in some instances permanently bene-
ficial.

The Patients are said frequently to look forward to the Eflfect on
service with pleasure, and to consider exclusion from it '^'■i^"*^-
as a privation. — Considering Religious Exercises in
Lunatic Asylums merely as medical aids, and conducive
to good order, they are of most important use. So long,
at least, as the Service lasts, they occupy the Patient's
mind, and set before him an example of quiet and deco-
rum. The Prayers of the Church are eminently calcu-
lated to produce a soothing influence upon even the
insane hearer. Instances of misconduct or disturbance
are said to be very rare ; and when they do occur they
seem to produce much less effect upon the other
Patients present than they would do upon persons not

160

Difference of
opinion among
Medical Offi-
cers, &c.

Appointment of
Chaplains de-
sirable.

Practice adopted
at various Asy-
lums,

accustomed, as the inmates of a Lunatic Asylum are,
to scenes of noise and confusion, and to the occurrence
of epileptic fits, or maniacal paroxysms, from day to day.

In the opinion above expressed as to the tranquillising
effect of Religious Exercises, — the Medical Officers and
Superintendents of Asylums — with whom we have con-
versed, are, almost without exception, agreed ; they
differ, however, somewhat, in their views with respect
to any permanent or lasting benefit being produced
thereby upon the minds of the Patients. The experi-
ence and observation of many Superintendents have
led them to the conclusion that the temporary effect
ceases with its cause ; and that after the conclusion of
the Service, little or no trace is left of its soothing
influence. They all concur in saying that Religious
Instruction injudiciously imparted, and Controversial
Discourses, are positively injurious.

Without entering into the question whether or not
Religious Exercises are of greater or more lasting benefit
to the Patient than is commonly attributed to them,
it is, we think, desirable, when practicable, to procure
the assistance of the Incumbent of the Parish, or of a
Clergyman in the neighbourhood, who should visit the
Asylum regularly, in the capacity of a Chaplain, and who
should be required to enter minutes of his visits in a book
to be kept for that purpose; and that entry should be
made of the number of Patients attending Prayers, from
time to time.

We have found, in some instances, that the Proprietor
of the Asylum, or one of his Superintendents, or
Keepers, or even one of the Patients, has been the only
person in the habit of reading the Church Service, or
other Prayers, to the Inmates. In one House (at Box)
a Patient^ obviously Lunatic, was permitted to exhort
his fellow- Patients every Sunday, in reference to their
Religious Duties, in an extemporaneous address. In
other places, a Keeper or Nurse (without any apparent

161

qualifications for rendering the subject as impressive as it
ought to be) has been the only person delegated to read
the service to the assembled Patients.

The Proprietors of some Private Asylums have
made arrangements, such as those to which we have
adverted, with the Clergy in their respective neighbour-
hoods. At Gateshead Fell Asylum, the Rector of
the Parish attends once in a month, on Sunday
eveningS) and performs Divine Service, which is
read on the intermediate Sundays by the Proprietor.
At Nunkeeling, the Incumbent of a neighbouring
Parish has recently been licensed as Chaplain to
the Asylum ; and at Gate Helmsley, a Clergyman
from an adjoining Parish attends regularly every Wed-
nesday, and reads the Evening Service, and "delivers a
short discourse to the Male and Female Patients
assembled Jogether. He also visits the sick. Similar
arrangements have for some years been in operation
in some of the larger Houses within the Metropolitan
District. We adduce these cases, to which we might add
others, as examples of those arrangements made volun-
tarily by Proprietors of Asylums, which we think desir-
able, wherever there are any considerable number of
Patients capable of benefiting by the assistance of a
Clergyman.

We will now briefly notice the County and other
Public Asylums; in the first of which we found, with one
exception, Chaplains appointed, or the duties performed,
(as at theDorset and Cornwall Asylums,) by the Chaplain
to the County Gaol. At Chester there was no Chaplain,
and the Service was read on Sundays by the Head
Keeper and Matron respectively, on the Male and
Female sides. We were informed that a Chaplain was
about to be appointed ; and this was found, upon our
second visit to that Asylum, to have been done. In
some County Asylums, a large proportion of the Pa-
tients attend the Service. This is the case at Chester,
M

162

where the Service is now read, and a Sermon delivered
every Sunday evening-. The effect is stated to be
generally tranquillizing, and some of the Inmates appear
to derive consolation from joining in it. At Leicester,
the proportion of Patients who usually attend Chapel
is about two-thirds of the whole ; at Bedford, Bodmin,
and Stafford, one-half; at the Dorset Asylum, one-third ;
and at Lancaster, one-fourth. The smallest proportion
which we have found attending Chapel was at the
Suffolk Asylum, viz., about 36 in 216, or one-sixth.
The Medical Superintendent of this Asylum stated as
his opinion, that the beneficial effect of the Service
was doubtful, the number of those capable of under-
standing it being very small.

We had an opportunity of observing the quiet and
orderly demeanour of the Patients during Service on a
Sunday, at Lancaster ; and of witnessing the effect appa-
rently produced upon about seventy of each sex, by the
appropriate and impressive discourse of the Chaplain.
At the Northampton Asylum also, we availed ourselves
of an opportunity to attend the Morning Daily Prayers,
which were read by a Chaplain, who visits the Asylum
daily, and has keys of the wards. The conduct of the
Patients was orderly and decorous.

The Chaplain to the Bedford Asylum, with whom we
had some conversation, expressed very decided views as
to the comfort and benefit derived by Patients from
Religious Services ; and mentioned the case of a female
who, upon recovering her reason, described the pleasure
she had experienced, whilst Insane, in attending Prayers.

The average number attending Chapel at the
Han well Asylum is 300, and the Holy Communion is
administered to those who are considered in a fit state
of mind to receive it. The practice adopted at Hanwell
in regard to the selection of Communicants, is that, one
fortnight before the quarterly administration of the Lord's
Supper, the Keepers and Nurses are directed to give

163

iiotice to the Patients in their several wards, and to in-
quire whether any of them desire to attend. Usually
about fifty of each sex express a wish co do so. Their
names are taken down, and from their number the Chap-
lain selects those whom he thinks in a fit state to
receive the Communion, These are on an average fifty
in number ; namely, about thirty males, and twenty
females. Their demeanour is said to be uniformly suit-
able to the occasion.

There is no Chaplain at the Lincoln Asylum. Prayers
are read daily, and twice on Sundays, by the House-
Surgeon, who considers the effect very beneficial,
as tending, amongst other things, to revive devotional
feelings. The result of our inquiries at St. Luke's
Hospital was, that Prayers had never been read to the
Inmates of that Institution ; but that a Chapel was in
progress of being fitted up, and a Chaplain about to be
appointed. At the Warneford Asylum, near Oxford,
a Chapel has been recently built, for the use of the
inmates.

VII.

ON THE ADMISSION AND LIBERATION OP
PATIENTS.

The law has required that no person, not being a Order and Cer-
Pauper, shall be received into any Licensed House for f^^^es required

'■ -' tor aduiission ot

the reception of Insane Persons, without an order, Patients, not
under the hand of the person by whose direction he is LkenTed
sent, and without the Certificates of two medical men. houses.

The order is to contain a full description of the Luna-
tic, and the name, place of abode, and degree of rela-
tionship, or connexion with the Lunatic, of the person
signing the order. The medical men signing the Certi-
M 2

164

Visitors to ex-
amine Orders
and Certificates.

Orders and Cer-
tificates not
required by
Public Hospi-
tals :

ficate are to examine the Patient separately, and are
to comply with other particulars required by the Act
of 2 & 3 Will. IV. c. 107. These Orders and Certificates,
and the different particulars which they require, have
been framed for the protection of the liberty of the sub-
ject, and for the prevention of abuse in improperly con-
fining those who are not insane.

The persons who are appointed to visit Licensed
Houses are required to examine these Orders and Cer-
tificates. We consider this duty to be one of great
importance, and are careful in our visitations to call
attention to any irregularity which we discover in
these documents. They enable us, in cases of difficulty,
to communicate with the family of the Patient, and with
the medical men who have signed the Certificates.
Copies of the Orders and Certificates are sent to our
Board, and enable us to give information of any person
who has been placed in confinement.

By 9 Geo. IV. c. 41, Public Hospitals were required
to have Orders and Certificates of Insanity in the same
form as Licensed Houses, but the clause requiring such
Certificates was omitted in the Act of 2 & 3 Will. IV.
c. 107. Private Asylums are not only required to have
Orders and two Certificates previously to admission,
but are subjected to visitation, whereas Public Hos-
pitals may not only receive Private Patients without
any Order or Certificate, but are not subject to any
visitation. In 1815, the then Commissioners in Lunacy
recommended to the Committee of the House of Com-
mons on Madhouses, that the exemption of Public
Hospitals for the Insane from the law for the regulation
of Licensed Asylums, " should be confined to Pauper
Lunatics admitted into such institutions as objects of
charity, and not extended to those who pay, and some-
times largely, for their accommodation." All the Lunatic
Hospitals, by their own private regulations, require
Certificates, before the admission of Patients, and gener-

165

ally in the same form as those which are required by law
for Licensed Houses. This shows the opinion of the
governing bodies of these institutions as to the propriety
of requiring them.

It is to be regretted that any difference has been Orders and
made in the forms of admission of Private Patients into desirable in all
any description of Asylum. No person ought to be •^^^^®'
placed in confinement except under the strongest sanc-
tion for its necessity, and under the written authority
either of relatives or other persons, who may be applied
to in case of doubt or difficulty. There is at least as much
reason for requiring Orders and Certificates on the admis-
sion of Insane persons into Public Hospitals, as into
County Asylums.

A gentleman who was a Private Patient in the County irregulariiies
Asylum at Leicester, complained to us that he was con- '=°°^^^"^"'^

•^ ' r upon the S3'stem

fined upon the Certificate of one medical man, who was of admission

1 • XII -I • /. 1 -IT- • • i'l Public Hos-

a relation, it has been the practice of the visiting pUals.

Physician of the County and Subscription Asylum at
Nottingham to sign Certificates for the admission of
Private Patients into this Asylum. As regards Licensed
Houses, such Certificates would be deemed irregular.
In the Lunatic Asylum at Northampton, a Private
Patient was pointed out to us by the Physician who was
not insane, but had been sent there because her habits
were a source of annoyance to her family. At the
Public Hospitals, as well as at other Asylums, we meet
with cases of persons who are termed morally insane,
about the propriety of whose detention there are fre-
quently great doubts.

The provisions of the law respecting Certificates and Remarks on
Orders for the admission of Insane persons into Asylums, P™^'sions of the

^ ./J ia^v tor admis-

require some notice. As regards Private Patients, Cer- sion into Asy-
tificates of their insanity from two medical men are
required for their admission into a Licensed House, anc?
from only one medical man for their admission into a
County Asylum. As respects a Pauper Lunatic, the

166

Practice at St.
Luke's Hospi-
tal;

At the Glou-
cester Asylum.

Act 2 &3, Will.
IV. c. 107, ss.
46 & 47, dis-
icgarcled.

Certificate of his insanity must be signed by one medical
man, and the Order for his admission into a County
Asylum must be signed by two Justices, if for a
pauper belonging to the county, and by one Justice if
for a pauper of another county ; and by one Justice, or
by the officiating Clergyman of the parish and one
Overseer, if for his admission into a Licensed House. It
appears to us to be desirable to have one form of Orders
and Certificates for the admission of all Private Patients,
and one form also for the admission of all Pauper
Patients, into Asylums of every description.

At St. Luke's Hospital, the Governors are in the
habit of permitting Patients to go to their friends upon
trial, and of re-admitting them as old Patients, without
requiring any fresh Certificate, Hospitals are enabled
to do this, because they are not required by law to
have any Certificates for the admission of Patients.
The subject has been frequently mentioned to us by the
Proprietors of Private Asylums, and it may deserve
consideration whether or not a power to permit the
temporary removal of Patients, on trial visits, or for
change of air, can be safely conceded to the keepers of
Licensed Houses. If such temporary removals, or
trial visits, are to be permitted, we think they should
be allowed only under the express sanction and autho-
rity in each case of Visiting Justices or Commissioners,
after due inquiry.

At the Gloucester Asylum, as has been stated to us,
the Superintending Physician permits Patients, before
they are discharged, to go home to their own families,
and receives them again without requiring fresh Orders
and Certificates ; and ten or twelve Pauper Lunatics
appear to have ingress and egress from the Asylum at all
times, at their own discretion. This practice is contrary
to law, and appears to us to be open to serious objections.

By the Act 2 & 3 Will. IV. c. 107, it is a misde-
meanor to receive to board, or lodge, in any house not

167

licensed, any Insane Person, Pauper, or otherwise,
without having the usual Order and Certificates
required for Private Patients confined in Asylums, and
copies of such Order and Certificates are directed to be
transmitted to the Clerk of the Metropolitan Commis-
sioners in Lunacy. The la\y in this respect appears to
be wholly disregarded as respects Paupers, and very
much evaded as respects Private Patients. No Orders
or Certificates whatever, authorizing the reception
of Paupers, are ever sent to our clerk, and those
relating to Private Patients are so few in number as
to render it manifest that the most culpable negli-
gence exists. The 47th section of the above Act does
not require the Orders and Certificates to be sent until
within twelve months after a Patient has been received.
The length of time allowed to send in the Orders and
Certificates has, we incline to think, been one cause of
the provisions of the Act being evaded. "We have
reasons for believing that the Proprietors of Licensed
Houses receive Private Patients in lodgings, without
ever making any return of the Orders and Certificates,
which they are required to receive and to transmit to
our clerk.

The object of the Law in requiring these Orders and Object of Orders
Certificates is, that the place wherein every Lunatic is
confined, may at all times be known, with the view of
ascertaining his condition in reference not ouly to his
state of mind, but also to the treatment which he re-
ceives from the person with whom he is resident.
From the information which we have obtained from Pauper Lunatics
various quarters, there can be no doubt but that Pauper justmable re^-"
Lunatics have been, and still are, subject to very severe straint.
and unjustifiable restraint, in cases where they are singly
confined, or boarded out in the houses of persons who
receive them for small sums. In the County Asylum
at Leicester there is a man now daily at work, and
apparently cheerful and in good bodily health, who, for

168

seven years previously to his admission, was kept
chained night and day in a small back room at Peckle-
ton, in the same County. In the Asylum of Plymp-
ton St. Mary, there is a Male Lunatic who was for-
merly a Boarder for eleven years in a Private House,
and during the whole of that time he was constantly
chained. We found him without any restraint, and
at work in the grounds of the Asylum. A poor
woman was removed from the Asylum at North-
ampton to board with another Patient ; but it was
found absolutely necessary to send her back (twice)
to the Asylum, because slie was kept upon so low a
diet that relapses of her disease were brought on by
want of more liberal food. "We have elsewhere stated
our reasons for thinking that the condition of Pauper
Lunatics, who are placed out as Boarders, deserves the
attention of the Legislature.
Liberation of The Liberation of a patient once properly certified to

be Insane, manifestly requires the greatest caution.
In almost every case, in which we have interfered to
promote the liberation of a person confined as a Lunatic,
we have considered it advisable, in the first instance, to
recommend that the patient should be removed by his
friends ; and it has been only on the refusal of the friends
to act on our suggestion, that we have resorted to the
power vested in us by the Acts of Parliament. In
numerous cases, we have found, tliat the mind of the
patient, even where he has derived benefit from having
been confined in an Asylum, retains a feeling of ani-
mosity towards the persons who originally authorised
his confinement, and an impression that he has been
injured by them. "We have, therefore, thought it right
that these persons should have the opportunity, at a
proper time, of doing an act which would, in all pro-
bability, tend to remove or lessen this unjust feeling;
and indeed it is not imimportant to the future well-
doing of the patient liiraself, that he should recom-

Patients.

169

mence his career in society with as few hostile prejudices
and unfounded opinions, and in general with as little
recurrence to his past state of mind, as possible.

Instances are, besides, perpetually occurring in which Suggestions as
a patient, although not completely recovered, is never- dual^liberation."
theless in such a state of convalescence or improved
health, as to render it desirable that he should have a
certain amount of liberty allowed him, without possess-
ing entire freedom. The transition from strict seclusion
to complete liberty of action should, in many cases, be
gradual. This is material, not only for the sake of
tempering the patient, and inuring him, by a regular
process, to unrestrained intercourse with society; but
also as a test whereby his fitness for liberation may be
ascertained, before he is made absolute master of his own
actions. Endeavours, it is true, are made, in some of the
better conducted Lunatic Asylums, to eficct this object,
by classifying the patients, and regulating the degree of
freedom allowed, by their advance towards recovery ;
but there are cases where it may be preferable to remove
the patient altogether from an Asylum, and from the
presence of companions of disordered intellect, and to
accustom him (under the supervision of a single attend-
ant) to associate only with persons who are perfectly
sane. This plan, by leaving in the hands of the patient's
friends a certain power, which they themselves may
gradually relax, invests them at once with the means of
control, so long as it may seem necessary to exert it,
and a considerable moral influence afterwards, when they
have of their own accord restored the patient to the full
enjoyment of his liberty.

In reference to cases of this sort, where great improve- Commissioners

, i_ , jy p . i.j.1 1 -ii Dot empowered

ment, short oi pertect recovery, has taken place m the ^^ T partial

health of a patient, it may be observed, that by the liberty.

Acts 2 & 3 Will. IV. c. 107, and 5 & 6 Vict. c. 87,

under which our authority is derived, we are empowered

to liberate patients altogether; but that we have

170

no power to direct the continuance of any control or
management after they have quitted an Asylum. The
liberation of a person confined as a Lunatic, if it be
effected by the exertion of our statutory powers, must
be complete.
Difficulty in Besides the cases last adverted to, there are others, not

deciding on libe- „ . , . ,

ration in certain 01 partial or mcomplete recovery, but where the amount
^^^^^- or character of the disorder is of such a nature as to

present great difficulties in the exercise of our discre-
tionary power of liberation. These are chiefly cases, 1st,
of drunkenness ; 2d, of epilepsy and periodical excite-
ment ; 3d, of weakness of intellect ; and 4th, of what
has been termed moral insanity.

Without laying down any precise rule on the sxibject,
we have assumed, as a general principle for our guidance,
that wherever a man of ordinary intellect is able so to
conduct himself, that he is not likely to do injury, in
person or property, to himself or others, he is unfit to
continue as the inmate of a Lunatic Asylum. In judg-
ing, however, of this likelihood to do injury, — in antici-
pating, in short, the future good conduct of a person
who has been once insane, from the present abated state
of his malady, or from his apparent recovery, there is
frequently extreme difficulty and always the most
serious responsibility. In some cases, insanity may have
been produced by temporary causes, which being re-
moved, little probability exists of a return of the com-
plaint. But the majority of cases proceed either from
congenital causes, or from some organic defect in the
system, inducing periodical returns of the disorder, in
each of which cases there is little chance of complete
cure ; or else from the depraved or imprudent conduct
of the patient, against the repetition of which there can
be. no security, that he will not relapse : there are cases
also where the intellect possessed by the patient is so
feeble or limited as to render it exceedingly perplexing
to decide, whether he is or is not fit to be intrusted with

171

the management of his own affairs : and there are others,
which modern writers class under the head of Moral In-
sanity, many of which are scarcely distinguishable from
cases of ordinary crime. It appears to us that these
last, if admissible as instances of actual disease, should be
admitted only after the most careful and severe scrutiny ;
and that the shelter of a Lunatic Asylum should not be
furnished, except upon incontrovertible grounds, to
persons prima facie liable to be dealt with by the
criminal law of the land.

In all cases, whether of these or other species of Patients should
insanity, it is clear that the patient, who apparently competenTper/

has claims to be liberated, should be examined and sons, previous to

liberation,
liberated only by persons familiar witli the disease, and

as a consequence accustomed to observe the peculiar

habits and moods of mind of the insane.

So far as respects the exercise of the power of liber- Exercise of

ation by the County Magistrates, we believe that a tyld^strates."

patient has very rarely been discharged by them until

he has been in a fit state to be restored to society ;

there have been one or two instances, however, in

which they appear not to have acted with their usual

discretion. At the Witney Asylum, the Visiting

Justices (with their medical attendant), examined a

patient, who was confined there, and had been guilty of

violence, twice in one day, and thereupon expressed

their desire that the proprietor of the Asylum (a

respectable medical man), would open his doors and let

the patient out at once. He refused to do this without

an order. The Justices urged this liberation, on the

advice of their medical attendant, who had never seen

the patient until that day ; and they soon afterwards

brought the matter before our consideration, and two

members of our body accordingly investigated the case;

but they, after repeatedly examining the Lunatic, and

hearing the evidence of various persons respecting his

conduct and general habits, whilst out of the Asylum,

17-2

did not feel themselves justified in liberating him. It
is right to add that this Lunatic, although somewhat
abstracted and moody, did not present very obvious
marks of disease. The testimony, however, corrobora-
tive of his disordered state of mind, which was given
by several persons, apparently unbiassed, was very
strong.

At the Licensed House at Nunkeeling, near Bever-
ley in Yorkshire, the Visiting Justices liberated a dan-
gerous Lunatic under unusual circumstances. We were
informed by the brother-in-law of the Lunatic, and by
the Proprietor of the House, that the Lunatic had been
in a state of continued drunkenness for many weeks ;
that he had threatened the life of his wife and child,
under a delusion that he was not the father of the
child ; and that two of the Lunatic's brothers had died
insane. We found the following entry made by the
Visiting Justices in the Visitors' Book, Dec. 19, 1842.
" We have this day made a special visit to the Asy-
" lum in order to examine into the case of P. H."
(the Lunatic referred to), " who has been placed here
" at the instance of his wife. He appears to be per-
" fectly sane at the present, and unless sufficient cause
" for his further detention be shewn to the Magistrates
" assembled in Petty Sessions at Leven, on Thursday
" next, the 22nd instant, we order that he be dis-
" charged from the Asylum on Friday, the 23rd."
This Lunatic had been confined under proper certifi-
cates, and the Proprietor of the House remonstrated ; but
the man was discharged, and afterwards threatened the
life of his wife, who was obliged to leave her home, and he
was then placed under the custody of the constables.
The Justices, according to the act empowering them to
liberate, ought to have visited this Lunatic three times
(instead of once), and the real power of liberation
belonged not to them, but only to the Justices assembled
in Quarter Sessions: and we entered a statement to

173

that effect in the Visitor's Book, and pointed out the
great risk of liberating a dangerous Lunatic under such
circumstances. Cases of this sort, however, are, as we
have said, extremely rare.

But liberations or removals at the instance of the Frequency of
patient's friends, or parish officers, are continually '"^^" ^^
taking place ; generally, indeed, only when the patients
are reported convalescent, but frequently without the
sanction of any visitors, and sometimes even against
their remonstrances. With respect to patients who
have ever been guilty of violence, it appears to us
very questionable, whether their friends, or parish offi-
cers ought, in any case, to have the power of authorising
or procuring their discharge without the previous sanction
of the Commissioners, or Visiting Justices, or other
competent authority. At present, a violent Maniac,
confined in a licensed Asylum, may, as it appears, be
liberated and thrown back upon society, by the mere
order of the relative, or other person, who originally
placed him there. Now, whether this liberation be
obtained by the importunities of the patient, or take
place in order to save the expense attending his confine-
ment in a Lunatic Asylum, or proceed from any other
cause, short of the deliberate judgment of persons accus-
tomed to observe cases of Insanity, it is, or may be,
equally injurious to the public welfare. This power of
liberating dangerous Lunatics, vested in or assumed by
incompetent and irresponsible persons, is a subject that
we think deserving of grave consideration.

In reference to this part of the subject, we beg to Cases of irregu-
state, that on our visiting the Refuge, at Hull, we found ^^"^ '^e"'"^'^*-
an entry made by the Visiting Justices, disapproving of
the removal of certain paupers by parish officers. From
the inquiries we there made into the matter, we were
induced to concur in opinion with the Justices, and
we accordingly made an entry in the Visitors' book to
that effect. Three cases were subsequently brought under

174

our notice by the clerk of the Visiting Justices of this
Asylum. One was that of a quarrelsome Idiot, who had
been confined for threatening to stab another person.
The other two were Imbeciles ; one having been ad-
mitted for obscenity of conduct, and the other being
subject to fits of great excitement, and of considerable
duration. Of these patients, one was removed by the
Overseer, and the other two were discharged by two
Justices of the county, who were not the Visitors.
The letter accompanying the order for the removal
of the Idiot, stated that she was not to be placed
in the Union House, but with some quiet old woman.
Two of these patients were dangerous, and all were
removed uncured, in opposition to the opinion of
the Visiting Justices, and of the proprietor of the
Asylum. A fourth patient had been confined because
she had taken a violent and unfounded dislike to her
husband, and had threatened to poison him. She was
removed on the day of our visit, by her husband,
against the remonstrances of the proprietor of the
Asylum, and notwithstanding that she had still the
same dislike and expressed the same threat as formerly.
We found in the same Asylum, a patient (a young
man) who had been twice previously discharged; the
second time contrary to the opinion of the superinten-
dent, who did not consider him convalescent. Shortly
after his second discharge, he met a relation whom he
passed and afterwards followed and stabbed danger-
ously in the side with a knife. He is now confined as
a criminal Lunatic. The superintendent considered
that this outrage would have been avoided, if he
had had power to delay for a short time the patient's
discharge.

In the Asylum, at Newcastle-upon-Tyne, there was
an extremely dangerous man, who had threatened the
lives of his wife and children. When we saw him, he
appeared perfectly rational, and we were informed that

175

he was staying in the Asylum in the hope of escaping

the consequences of legal proceedings, commenced

against him for some offence. The resident Physician ^

was of opinion that this man had sought shelter in the

Asylum from the proceedings, and that (although a

dangerous Lunatic) he would obtain his liberation as

soon as all danger should have passed.

It will be observed, that one of the cases which we Difficulty of
have adverted to, as involving great perplexity, is that casesTf d'unk-
of a patient whose insanity has arisen from drunkenness, ^nness.
and who has apparently recovered. Such a person, at
the commencement of his disease, is generally in a state
of violent excitement, and likely to do injury to him-
self or others. Cases of this description have fre-
quently come under our consideration, within the
Metropolitan district and elsewhere ; and the difficulty
which we have experienced has been to determine for
how long a period the patient ought to be detained in
confinement after his malady has apparently ceased.
We have thought it desirable that he should not be
exposed too soon to the temptation of again indulging in
strong liquors ; it having been almost invariably found
that patients of this class, if liberated without having
undergone a sufficient probation, are very liable to resort
to their former practices, and to relapse. At the same
time, we have considered that a Lunatic Asylum is not
a place for the permanent detention of persons who
have recovered the use of their reason, and are not
obnoxious to the charge of unsoundness of mind, other-
wise than on account of their liability afterwards to run
into their former excesses, when restored to liberty. It
has been our practice, in cases of this sort, to liberate
the patient after a short confinement, if it be the first
attack of Insanity from this cause, and if he appear to
be aware of his misconduct, and to have a desire to
reform his habits. In the event, however, of his being
confined a second time owing to the same cause, we

176

have felt that his probation ought to continue for a
much longer period ; and indeed we have felt that great
responsibility has rested upon us in such a case, and
have at all times very reluctantly, — and only after
vainly endeavouring to induce the patient's friends to
take charge of him, — resorted to our power of liberation.
Instances of sane In reference to the subject of liberating patients, it is
senuo Asylums, ^'^g^^ ^0 state that, in the course of our experience, we
^^^^' have rarely found any patient confined in a Lunatic

Asylum, who, as far as we could judge, had been sent
there whilst in a decidedly sane state. Occasionally,
the reasons for confining a patient at a great distance
from his home, or for afibrding him an allowance
apparently incompatible with his means, have required
explanation, and this has not perhaps always proved
satisfactory ; but there have been very few instances
where the condition or conduct of the patient has not ■
been sufficient to justify or extenuate his confinement.
Confinement At the same time, it must be added that confinement
mu^crprolonged. ^^^ ^^ many cases been too far prolonged, and we have
not unfrequently encountered a reluctance, on the part
of the patient's relatives or parish officers, to remove
him when he has been considered convalescent, and
when in our opinion he might have been removed from
the Asylum without danger. In the case of Private
Patients, the reluctance of the relatives has often pro-
ceeded from timidity, and occasionally perhaps from a
wish to conceal the fact of the patient's insanity ; whilst
the reluctance of parish officers has, without doubt,
frequently arisen from a desire of saving expense, or
from the circumstance of the patient having been found
troublesome in the workhouse or union. In many of
these cases, the parties have evidently been anxious to
throw all the responsibility of the Act of Liberation
upon the Metropolitan Commissioners.

Power of libera- It is under circumstances of this nature, and also
tion should be , ,, • • n • • .1 j !• ^i

vested in some where the person originally signing the order for the

177

patient's confinement dies or goes abroad, (such person's persons under

consent being required previously to the patient's dis- ^^"'^j'^'^ ^^ ^^°

charge,) that we have felt our power of liberation to

be of the highest importance and utility ; and we think

that some such authority should always, under the

sanction of the Legislature, be vested in some persons,

in order to ensure due protection to the subject.

VIII.

STATISTICS OF INSANITY.

■ The importance of Statistics of Insanity, and their General obser-

intimate bearing upon the more immediate subjects of our ^**'°°^-

inquiry, have induced us to resort to all accessible sources

of information, for the purpose of estimating the actual

numbers of the Insane, of all ranks, in England and

Wales ; and of presenting, in one view, the numbers,

with the several classes and conditions, of those confined

in Asylums. Our inquiries have also comprised the

prevailing forms and causes of Insanity, and causes of

death, with the results of treatment, as far as they are

deducible from the records of admissions and discharges.

We have thought it expedient to confine ourselves,

upon this occasion, to a few important heads, reserving

others for future investigation. One reason for thus

limiting our inquiries was, that, whilst it was desirable to

collect the information from the various Asylums, public

and private, in a uniform shape, many of those Persons

by whom it was to be supplied were not in possession of

suflScient data to enable them to furnish all the required

details.

The subject is one upon which, from the scanty and Erroneous no-
uncertain nature of the materials for computation, the tj,g gybiec^

178

Returns of Pau-
per lunatics.

Reports of
County and
Public Asylums.

Commissioners,
inquiries ex-
tended to Scot-
land and Ireland

most erroneous notions have been formed by several
writers who have treated upon the Statistics of Insanity
By one writer, the number of the Insane in England was,
in the year 1810, estimated at one in 7,300 of the popu-
lation; by another, in 1820, the number was estimated at
one in 2,000; by a third, in 1829, at 16,500, altogether,
in England and Wales. It will be seen, in a subsequent
part of this Report, how very far these estimates were
from the truth.

The means of arriving at a nearer approximation to
the real numbers of the Insane in this Kingdom, have
been furnished by certain returns of Lunatics and Idiots
chargeable to Unions and Parishes, in the years 1836,
1842, and 1843. Abstracts of these Returns have been
prepared by the Poor Law Commissioners, and a copy of
the last of these Abstracts will be found in Appendix F
to this Report. The printed Reports of the various
County and other Public Asylums, and the Statistical
Tables drawn up by the Medical Officers of those In-
stitutions, supply most valuable information. They are,
however, plainly insufficient for general deductions.
These circumstances, and the importance of the subject,
led us to undertake the inquiry, the results of which we
now present to your Lordship. Our acknowledgments
are due to the Superintendents and Proprietors of Asy-
lums, generally, for the readiness with which they sup-
plied the information requested, and the labour bestowed
by them upon their several Returns.

We have (as will be observed) extended our inquiries,
in a certain degree, to Scotland and Ireland ; in regard
to which, we availed ourselves of the best private chan-
nels to request information from the principal Institutions
in Scotland ; the several District Asylums of Ireland ;
Swift's Hospital, Dublin : and the large and important
Pauper Asylum, at Cork. Our request was met most
cheerfully by the Managers and Medical Officers of those
Institutions, who have favoured us with Returns for the

179

most part full, and complete, which will be found at the

end of the Separate Appendix. We have thought it due

to the Parties furnishing the Returns, as well as desirable

in other respects, to append to them extracts from the

several communications by which they were accompanied,

so far as the same appeared necessary for their elucidation.

We come next to speak of the materials for the Registers, &c.

statistics of Insanity, which exist in the shape of Returns ^^^^H be°kept

required by Law, We shall, in the concluding portion in ^ prescribed

form,
of our Report, submit to your Lordship our views as to

the propriety of prescribing certain forms of Registers and
Medical books, to be kept in all Asylums, with a view to
the preparation of Statistical Returns, at stated and uni-
form periods. The absolute want in some cases, and the
deficiency, and variety in form generally, of such Regis-
ters, have tended much to enhance the difficulties we
have had in procuring the necessary information, and to
render it a work of much labour to the several Superin-
tendents to supply it in the shape that we requested.
The circumstance also of several of the Public Asylums
making up their Annual Statements to a period of the year
other than the 31st of December, has been a source of
much additional trouble and inconvenience to some to
whom we have been indebted for Returns applicable to
the 1st of January, 1844.

To revert to the subject of the Returns now required Ketums re-
by Act of Parliament. The visitors of each County ^^^ ^ ^^'
Asylum are bound by the Act 9 Geo. IV. c. 40, s. 56, to
make annual Returns, * in the month of June, of the
patients confined therein, or who shall have been confined

* The Lists of Patients in County Asylums are directed to be
sent to the Clerk of the Metropolitan Commissioners, appointed under
the Act 9 Geo. IV. c. 41, who is to enter the same in a Register.
The last-mentioned Act having been repealed, and the Metropolitan
Commissioners being now appointed under the Acts 2 & 3 Will. IV.
c. 107, and 5 & 6 Vict. c. 87, some County Asylums make no
Returns to this Board.

180

not regularly
made.

Eeturn by Visit-
ing Commis-

by proprietors
of Licensed
Houses.

therein within the twelve months preceding; and similar
Returns are required by the Act 2 & 3 Will. IV. c. 107,
s. 63, from Public Hospitals and Charitable Institutions.*
These Returns, if universally made, would supply much
useful information under the several heads to which they
relate, more especially as to the Occupation and Profes-
sion of the patients. It appears, however, by the collection
of Returns, relating to County Asylums, printed by order
of Parliament in 1842, that they are not universally made,
and that some of those made apply only to the Patients
admitted during the year.

The Yisiting Commissioners are directed by the Act
5 & 6 Vict. c. 87, s. 36, to require and transmit to this
Board, a List, according to the form in Schedule B to
that Act, of Admissions, Discharges, and Deaths, during
the year ending the 31st December preceding. No one,
however, is named in the Act to furnish the List.f

As respects Licensed Houses, the Proprietors are
required by the Acts 2 & 3 Will. IV. c. 107, ss. 30, 31,
and 3 & 4 Will. IV. c. 64, ss. 3, 4, within two days after
the Admission, Discharge, or Death of Patients, to trans-
mit to the Clerks of the Peace, in the case of Pi-ovincial
Asylums, and to this Board in all cases, copies of the
Orders of Admission, and Medical Certificates, and
Notices of Discharge, or Death, as the case may be,
to be entered in a Register, by reference to which, the
fact and also the place of confinement of any Inmate
of a Licensed House may be ascertained. :{: Similar
Notices are also required by the Act 5 & 6 Vict. e. 87,
s. 27, to be given of escapes. It is very important
that materials should be furnished for the formation of
a correct and complete Register of Insane persons,

* Xhe -A^ct does not specify the person -whose duty it shall be to
make the Return, which is in fact made by one Public Hospital only.

•j- The Superintendent of the Nottingham Asylum, on this ground,
declined to furnish the List ■when required so to do.

X The Commissioners have power to permit searches to be made for
this purpose.

181

whefever confined ; and that regular Returns should be
made, with this view, from all Asylums, Public and
Private, in a uniform shape.

The next class of Returns to which we shall advert, and Returns of Pau-

, . , . . ... 1 per lunatics and

which IS a most important one, as containing the only idiots. -
authentic information upon the subject, furnished to Par-
liament and the Public, applicable to the whole King-
dom, is that of Lunatics and Idiots chargeable to Unions
and Parishes. The Enactments upon this subject are
the 9th Geo. IV. c. 40, and the new Poor Law Amend-
ment Act, 5 & 6 Vict. c. 57. The first-mentioned Act
is now confined to Parishes not comprised in Unions,
the Overseers of which are still required, annually, in
the month of August, to transmit to the Clerks of the
Peace " lists of all Insane persons chargeable to their
respective Parishes." These Returns, it is believed, are
not very regularly made.

The principal Returns of Pauper Lunatics are those
made by the Clerks of Boards of Guardians, under
the New Poor Law Amendment Act. These last
Returns contain a variety of details, not supplied by
the former ; and, if filled up with care, and by competent
persons, would be more valuable, in a medical point of
view, than they now are. It is plain, from these
Returns, that a large number of Insane persons,
returned under the head of Idiots, are not Idiots pro-
perly so called, namely, Idiots from birth or infancy.
The Returns, however, may be generally relied upon
as regards the aggregate of Lunatics and Idiots charge-
able to Unions. These, it is to be observed, probably,
in many cases, do not comprise the Insane members of
families chargeable as Out-door Paupers, of the numbers
of which no means exist to form an estimate. There is
also another class of Pauper Lunatics not included in
the Returns; viz. — those maintained in Asylums at the
charge of the several Counties.

The only remaining Returns which we shall notice

182

are those required by the Act 2 & 3 Will. IV. c. 107,
sect. 47, in the case of single private Patients, and de-
" Private Re- nominated in the Act " Private Returns." They apply,
2 & 3 W. IV. however, to those patients only who have been under
*'' '^"'* the charge of the same individual for the space of one

year. Of patients who have been under private care
for shorter periods than a year, no Return is required ;
so that a large class of Insane persons under certificate
exists, in respect to whose number there are no materials
for calculation. As regards also those of whom Re-
turns ought to be made, it is believed that in a very
small proportion of instances is the law complied with.
This is abundantly manifest from the number, so far as
it could be ascertained, in the month of January, 1844,
and which was furnished to us with your Lordship's per-
mission. This number was 37 only ; viz. — 24 Males, and
13 Females. It is to be observed, also, that no notice is
required to be given of removal or death ; so that whilst,
on the one hand, a large number of certificated single
Patients may, and no doubt does exist, of whom no
Returns have been made, either from ignorance or neglect
of the provisions of the Act on the part of the Persons
having the charge of them, or because such Patients
have not been under the care of any one Person con-
tinuously for so long a period as a year ; on the other
hand, those of whom Returns have been regularly made
may have subsequently died, or been discharged, or
removed by their friends. For these reasons, we have
not taken the Class last mentioned into account, in our
estimate of the present numbers of the Insane. Even
if these Returns were complete, and all certificated single
Patients were comprised in them, there would still
remain a considerable class of Insane persons, of all
ranks of life, under the care of Guardians or Rela-
tives, without certificate, of whose probable number
there are no means of forming an estimate. These
considerations, as well as those suggested as to'

183

the numbers of the Insane Poor, are necessary to be
borne in mind, in all calculations relative to the amount
and prevalence of Insanity in this Country.

With these remarks upon the existing' materials for Course pursued
the Statistics of Insanity, we proceed to state to your sionerri^'their
Lordship the course we pursued, and the nature and inquiry,
objects of the Tables which we issued to the several
Superintendents of Asylums. Copies of the Returns
received, with a Tabular View of the state of the
Patients in each Asylum on the 1st of January, 1844,
will be found in a Separate Appendix.

This Tabular View, to which we allude first in order,
as forming (with information derived from other sources)
the basis of a Census of Insanity, contains, as will be
seen, a Statement of the Total Numbers of each sex,
pauper and private, confined in Asylums on the 1st
of January, 1844 ; their state as to probability of reco-
very ; the number of Epileptics and Idiots ; of those
with homicidal or suicidal propensities ; the condition
of the Inmates as to marriage ; their several classes of
life, and previous occupations ; the number of Criminal
Lunatics (commonly so called); and of the Patients
found Lunatic by Inquisition. It is only necessary to
observe, in respect to the Returns from which the State-
ment last mentioned has been compiled, that the greatest
pains have been taken to insure accuracy, by repeated
communications with- the various Superintendents of
Asylums, and by obtaining from them, whenever
necessary, explanations and corrections of their several
Returns.

The following Table exhibits the general results, in
which the numbers found Lunatic by Inquisition have
been corrected, by a statement furnished to this Board by
the Board of Visitors of Chancery Lunatics. To this we
subjoin a more detailed Abstract of the Returns made
to this Board from the several Classes of Asylums.

184

General Statement of Insane Persons confined in Asylums
England and Wales, I Jan. 1844.

Males.

Females.

Total.

Private Patients

Paupers

Total ....

1989
3532

1801
3950

3790

7482

5521

5751

11,272

State as

to probability

recovery.

^ ,1 fPnvate . .
Curable „

J Pauper . .

[.Total .

T ,, fPrivate
Incurable Ip^^p^^ .

[^ Total .

492
687

553

787

1045
1474

1179

1340

2519

1497
2834

1248
3157

2745
5991

4331

4405

8736

Epileptics

Idiots . . ....

Homicidal Patients ....

Suicidal Patients ....

575
347
180
303

376
251

98
393

951

598
278
696

Civil State.

Married
Single

Widowed .
Not known .

1501

3346

340

212

1664

2982

798

197

3165

6328

1138

409

Class of

life, and

occupation.

Upper and Middle Classes
Agricultural .
Artisan, and In-door
Others ....

1389
1183
1640
1187

1315

469

2228

1629

2704
1652
3868
2816

Criminal Lunatics ....

202

257

Found Lunatic by Inquisition .

146

233

185

CO o

-* OS

■0

CO TO

<0 Oi

00 r^

P<hlH

CO ^

05 CO

CO •^
irt crs
"» ^
O ©
. c<i to
i in CO

^
§

to CO 1
CO 'Ji 1
lO CO 1

t^ CD 1

00 to

01 -I 1

-* t^ 1

t^cO

in in 1

ca to
^^ 1

OD
00

i3
it

to OJ

05
in c^

!>.

03 1 1

"1 '

- 1

2 1

•<
^%

"o
H

in -^

"5 Cvj
i-H 00
1-1 (M

OS
CO
IM

CO to

OS
©
IM

S, H

04 Ph

IM t^ I OS

— . CO I ■*

-<}< to I o

lO I— I I to

C CO I CO

iM CO 10

t^ to I CO
IN C<3 I in

CO 00 I —
to <M I OS

to in I i-i

to
*o

OS OS 1 CO
to C<l OS
CO ■* 1 «>•

1— 1 -^ 1 in
lo 1— t 1 to
<»• CO 1 i-^

05 -T
© CO
JTji_(M_

CO in
eg CO

IM ^

■*

OS 1

■n

■'S'

■^

-tti

r— 1

t>.

eot>.

1— 1

■*

-a"

1— «

-* to

l>.

C^l

,_,

'S"

»C

1—1

nH © IM Ol
lO to to TT
IM i-l i-l

to ^ to Tf

I I IN in

I I

, , 04 CO
I I '^^

t- -"J" I in

!>.-.* I in

1-1 CO <M 1-1
1— I 0> uo rf
in IM —I CO

in -^ CO 03
I— I — in 03

(M nl >-l

to 05 ■^ <><

OS !>. c^ in

IM r-t 1-1

HP"

lO (N in -*

to I— 1 1-1 CO
to CO CO IM

•q* 01 OJ

OS — -^ 1-1

■*©©■*
It ^ — I

1— t in in to

GO CO 1-1 1*1
CO © IM 1—1

to 1-1 1-1 OS
© 01 !>. l>.
IM ^ -^

O) 10 CO J>.
(M CO t^ I-l

M in

to in cj in
iM ■^ in

^ OJ

CO © I-l oa

<M I IM I

O TT 10 CO

«>. j>. to to

Tt< CO tr 1— I
— < IM

-H 31 Tfl t^

CO © 1-1 00
!>. OJ CO

(M © in o
in OS in Tt<
e<i in 00 to

C<1 00 r-l ©

eg .n CO -*
to 1-1 tf is<

in »5 (^ <M I -^
CO 1* CO 1—1 1 eg
r^ rH in CO I

— — CM

to CO OS to
1:^ CO 3^ '^
CM ^ ,-< eg

CO
~l~oo~

1 -"T

'2 I

l>. © lO CO I © I

"= I 1^ I I I

I I I - i I i

O «:>. 00 J>. to

*^ in 05 !>. o;

(M *>• O) CO

eg 10 t^ t>.

in CO !>. 05

PH lO 00 -<*

C 2 is
3 C3 tn

0. bo fc, ^

The numbers as respects the Hanwell Asylum apply to the 30th of
September, 1843, to which the Return from that Asylum was made
up. The total numbers were on that day, 412 males and 563 femalesj
total 975; whilst on the 1st Jan. 1844, the toUl number was 982 ;
viz., 416 males and 566 females.

Patients in
Bethlem :

186

In the absence of any specific information upon the sub-
ject, we have entered the Criminal Lunatics in Bethlem
Hospital, viz. seventy Males and twenty Females, as
Paupers. We have also assumed that the remainder of
the Patients in Bethlem generally, are of the Private
class, although we have reason to believe that some of
them are maintained, wholly or in part, at the charge of
Unions or Parishes. Seven male, and nine female, curable
Patients, entered in the last printed Report, as " out
on leave," have been added to the numbers returned
as in the Hospital on the 1st of January, 1844.

The Return from the Asylum for the County of
Pembroke, at Haverfordwest,* as to the Patients confined
therein on the 1st of January, contained merely a state-
ment of absolute numbers, viz. eleven male, and six
female Paupers. These Patients, consequently, are only
found in the first Division of the Table.

With respect to " Civil State," and " Class of life and

and "Class of life previous occupation:" 232 Patients; viz. 122 Males,
and previous . , ,. . , .

occupation." and 110 Females (mcludmg those above mentioned m

the Pembroke Asylum) do not appear under either of

those Heads, the Returns received not having supplied the

necessary information. The numbers omitted under the

Heads to which we have last alluded are as follows, viz. ;

at Haverford-
west.

' Civil state,''

Males. Females. Total.

Haverford West Asylum .

. 11

Bethlem Hospital

Out on leave .

. .

Incurables .

Criminals

. .

Guy's Hospital

Total .

122

110

232

It is necessary to state this, in order to account for

* No notice whatever was taken of any of the repeated applica-
tions made for information ; nor was any answer received from this
Asylum, until after the interference of the Chairman of Quarter Ses-
sions, to whom a letter was addiessed upon the subject.

187

tients.

the apparent inaccuracy of the general statement in the
above respects.

The condition of Pauper Patients in Asylums, as to Curable pa-
probability of recovery, being made the subject of
frequent observation in other parts of this Report, and
being matter of great public interest, v?e have drawn
up from the Returns the following Synopsis, which
shews at one view the state, in this respect, of the
Pauper Patients confined in the several Classes of Asy-
lums, on the 1st of January, 1844 : —

State of Pauper Patients in Asylums, as to Probability
OP Recovery, 1 Jan. 1844.*

Where Confined.

Total Number of
Pauper Patients.

Curable.

Proportion

per cent.

of curable

to total

Number.

1951
177

360
947

2276
166

494
973

Tot.

4227
343

854
1920

•297
28

46
306

677

354
31

65
331

781

Tot.

651
59

111

637

1458

County Asylums . .
Other Public Asylums.
Licensed Houses : —

Metropolitan . .

Provincial

15f
17

33A

Total . .

3435

3909

7344

19^

The following Table exhibits the proportions per cent,
of Curable to Total Numbers of Paupers, in the several
County Asylums, on the 1st Jan., 1844, according to
the Returns made to this Board : —

Date of
Opening

County.

Per

Centage.

Date of
Opening

County.

Per
Centage.

1814
1837
1829
1812
1823
1812
1818
1832

Norfolk .
Leicester . .
Chester . .
Notts. ..
Gloucester
Bedford . .
Stafford .
Dorset

65|
50^
30i
29|
21|
191
19i
17f

1829
1818
1816
1833
1820
1831
1841

Suffolk ,
York W. Riding
Lancaster . .
Kent

Cornwall . .
Middlesex
Surrey . .

* Under the head County Asylums is included St. Peter's Hospital,
Bristol, which is made, by a Local Act, subject to the provisions of
9 Geo. IV. c. 40. The numbers in the Asylum for the County of
Pembroke, at Haverfordwest, for the reasons before mentioned, are
not included. St. Luke's Hospital is omitted, because of its particular
constitution, recent cases only being admitted in the first instance ; and
Epileptics, Paralytics, and Idiots, also aj;ed and infirm Patients, and
those previously discharged uncured from other Asylums, being inad-
missible;

General obser- The remaining Tables require few observations^

Vations on ve- —ii i • i n .,,.,..

tnaining Tables, ^hey were prepared with all practicable simphcity, and

in a form which was considered best calculated to obtain

the desired information. The Returns apply, as will be

observed, for the most part, to the period of five years,

ending in 1843, and, with few exceptions, on the 31st of

December.

Some of the Returns of Admissions, Discharges, and
Deaths, extend back to the dates of the opening of the
Asylums, thus supplying the entire numbers of Patients
who were in the Asylums at any time during the whole
pei'iod. In other cases the numbers in the several
Asylums, as they existed at the commencement of the
periods included in the Returns, only have been given.
For the purpose of Statistical deductions, the Returns
last-mentioned are the same, in substance, as the former ;
inasmuch as the Patients in each Asylum, at the time
from which the statement of events commences, may be
considered as having been then admitted, and the Asylum
as having been then opened.

With respect to the Per-centages of Cures and Deaths,
contained in the Table to which we shall next advert, a
diflPerence of opinion prevails as to the true principle
upon which they should be calculated. Some persons
are of opinion that they should be estimated upon the
average numbers resident in the Asylum during a given
period ; others upon the total number of discharges and
deaths ; and a third class upon the total number who
have been under care. We conceive that, for the purpose
of instituting a comparison between the systems of treat-
ment pursued in various Asylums, the first and second
methods should be employed. It is hardly necessary to state
that the greater the number of years over which the cal-
culation extends, the more accurate will be the deductions
drawn. It was our intention, in framing the Table, that the
Per-centages of Cures and Deaths should be estimated
upon the average numbers resident during each year.

189

The Returns appear to have been made, for the most
part, upen this principle. In some, however, other
methods have been adopted.

The following- Table exhibits the per-centages of Cures
and Deaths in the several County, and principal other
Public Asylums, as deduced from the Returns made to
this Board. Some trifling errors appear in those Returns,
but not of a magnitude to affect the calculations in this
Table.

Per Ckntages of Cures and Deaths in County and principal other Public Asvlums.

PROPORTIONS PER CENT.

On average num-

On total number of cases dis-

ber resident in

charged (including deaths).

Asylum

during
years.

Asylum.

Date of opening.

lasts

Since opening.

During last 5
years.

Annual

Cures.

Deaths.

Cures.

Deaths.

Cures.

Deaths.

County Asylums.

Bedford

Aug. 1812 .

15-9

10-5

39-7

23-3

44-3

29-3

Chester . .

Aug, 1829 .

30-1

11-8

59-0

30-0

63-2

24-7

Cornwall* . .

Aug. 1820 .

13-4

7-9

—

23-8

47-6

28-2

Dorset

Aug. 1, 1832

15-6

12-2

58-5

36-1

52-9

41-4

Gloucester

July 24, 1823

31-7

10-7

65-5

13-7

61-7

20-8

Kent . .

Jan. 1, 1833

7-5

10-7

38-3

47-3

35-0

50-0

Lancaster .

July 28, 1816

16-6

13-2

48-2

46-0

52-4

41-5

Leicester .

May 10, 1837

36-1

11-3

18-1

60-0

60-7

19-0

Middlesex .

May 16, 1831

6-7

9-1

37-4

55-7

38-7

52-9

Norfolk , .

May 18, 1814

13-3

19-1

52-3

45-4

37-9

54-4

Nottingham

Feb. 12, 1812

24-6

9-2

15-8

14-5

58-4

21-8

Stafford .

Oct. 1,1818

21-0

13-7

—

42-7

27-9

Suffolk

Jan. 1, 1829

16-1

10-8

50-4

33-7

52-6

35-3

Surrey . .

June 14, 1841

—

47-8

50-9

—

York, West Riding

Nov. 23. 1818

17-1

13-6

50-1

36-9

48-0

38-2

St. Peter's Hospital, Bristol

Incorp. 1696

20-3

19-7

46-0

27 3

33-0

32-0

Other Public Asylums.

Exeter

July 1,1801

47-6

12-4

54-1

9-2

47-6

12-4

Lincoln

April 6, 1820

17-9

15-0

42-2

21-9

33-1

27-8

Liverpool

April 6, 1792

62-7

16-7

41-2

31-4

8-3

Northampton

Aug. 1, 1838

30.3

14-0

58-6

28-3

59-6

27-5

Warneford, near Oxford

July, 1826 .

22-4

7-5

54-7

12-8

600

20-0

York Asylum . . . .

Sept. 20, 1777

7-9

6-8

36-0

21-7

35-6

30-6

Friends' Retreat, York

Midsm. 1796

8-2

5-7

54-6

26-7

45-6

31-7

The Superintendents of some large Asylums have,
in addition to the Returns requested, favoured us with

* The Return from the Cornwall Asylum gives the Average num-
bers and annual discharges and deaths, for the last three years only.

fSO

Total nurabers
of Insane.

some valuable statements which we have appended to
their several Returns. As respects Bethlem Hospital,
we have selected, from the printed Report of that Insti-
tution, some of the most material Tables upon the
several subjects embraced in the Returns from other
Asylums.

We proceed, in conclusion, to state, as far as cir-
cumstances admit and materials for computation exist,
the total numbers of Insane persons, Pauper and Private,
in England and Wales, on the 1st of January, 1844.
This statement, for the reasons we have given, can be
considered only as the nearest practicable approximation
to the truth. It may be depended upon, however, as
exhibiting the minimum amount of Insanity, ascer-
tained, or estimated upon authentic data.

It was first necessary to compute the entire number of
Pauper Lunatics and Idiots on the day to which the
Census of Insanity applies. The means of doing so were
furnished by the Abstract, to which reference has been
made, of the Returns from the Clerks of Boards of
Guardians, in August, 1843.

The following Tables formed the basis of our calcula-
tions : —

Number of Lunatics and Idiots chargeable to Parishes included in
Unions, in the years 1842 and 1843, according to Returns made
under the New Poor Law Amendment Act, 5 & 6 Vic. c. 57.

589 Unions,
Aug., 1842.

England
Wales

Population of the
Unions, according
to Census of 1841.

Lunatics and Idiots.

Total.

12,978,377
884,173

5803
507

6909
651

12,712
1,158

591 Unions,
Aug., 1843.

England
Wales

13,152,341
884,173

6248
523

7367
654

13,615
1,177

Total number of In-door and Out-door Paupers relieved

during the Quarter, ending Lady Day 1843 . . 1,539,490

Lunatics and Idiots, as above .... 16,641

Proportion per cent, to number relieved . . 1.08

191-

The two Unions which were formed, as appears by the
above Table, between the years 1842 and 1843, were
those of Oldham and Ashton-under-Line^ the former
containing a Population of 72,394, and the latter
101,570; together, 173,964.

Upon the assumption that the aggregate number of
Pauper Lunatics chargeable to Unions, bore the same
proportion to that of Pauper Lunatics belonging to
Parishes not in Union, which the aggregate Population of
the Unions, according to the census of 1841, bore to
that of the Parishes not comprised in Unions, the total
numbers of Pauper Lunatics in England and Wales, in
*he month of August of the years 1842, and 1843,
respectively, were as follows : —

August,
1842.

England
Wales

Population

of England and

Wales.

Lunatics and Idiots.

Proportion
per cent, to
Population.

ONE

Lunatic or
Idiotjto Per-
sons Living.

Males.

Females. Total.

15,253,890
927,335

6705
523

7983
671

14,688
1194

•096
•129

1039

777

Totals

16,181,225

7228

8654 15,882

•098

1019

August,
1843.

England
Wales

15,457,529
939,7123

715
539

8399
674

15,522
1213

•100
•129

1000

777

Totals

16,397,244

7562

9073

16,735

•102

980

It appears from the last Table that the number of
Pauper Lunatics, in proportion to the Population, had
slightly increased from August, 1842, to August, 1843.

We have taken the Population from the Enumeration
Abstract, presented to Parliament in 1843. We mention
this, in order to account for a trifling diflference which
appears between the above estimate and that of the Poor
Law Commissioners, who made use of the Population
Returns as first received, which were rendered more
perfect by some subsequent corrected Returns. A^^J/^

It is stated, by the Registrar General, in his report """^

^^^^ that <' the increase of Females," " in the ten years,

1831 — 1841, was 14.17 per cent, or at the rate of 1.334

192

per cent annually ;" and he assumes, for the reasons he
gives, that the Male Population increased at the same
rate ; and that the increase, in both cases, was " uni-
formly at that rate throughout the ten years."

The computation which we have made in the lastTable,
of the Population in August 1842 and 1843, respec-
tively, and in that which follows, on the 1st January
1844, has proceeded upon the hypothesis that the
Population has increased at the annual rate above men-
tioned, since the 6th of June, 1841, the date of the
last Census. It has also, in the Estimate given of the
actual number of Pauper Lunatics on the 1st of January,
1844, been assumed that their numbers increased, from
the date of the Poor Law Returns of 1843, in pro-
portion to the Population.

With this explanation, we present to your Lordship
the following statement, to which we have added a
Table, exhibiting the proportions per cent, on the 1st of
January, 1844, of the numbers of Pauper Lunatics,
Male and Female, in England and Wales, respectively,
to the population of each sex: — •

Total Number of Lunatics and Idiots Chargeable to
Unions and Parishes on the 1st of January, 1844.

England . .
Wales . . .

POPUI/ATION

of England and

Wales.

Lunatics AND Idiots.

Male.

Female.

Total.

15,535,621
944,461

7159
542

8442
678

15,601
1220

Totals.

16,480,082

7701

9120

16,821

193

Proportions per Cent, of Pauper Lunatics to Population,
January 1st, 1844.

England .

Males . .
Females .

Population.

Pauper Lunatics.

Proportion
per cent.

One Pauper
Lunatic to Per-
sons Living.

7,589,659
7,945,962

7159

8442

•094
•106

•100

1060
942

Total . .

15,535,621

15,601

1000

Wales . .

Males . .
Females .

463,985
480,476

542

678

•117
•141

856
709

Total. .

944,461

1220

•129

775

Total England & Wales

16,480,082

16,821

•102

980

Deduct Criminal Lunatics

279

Total Pauper Lunatics not Criminals

16,542

•100

1000

It will be observed that the proportion of Pauper
Lunatics to the Population is considerably larger in Wales
than in England ; and that in both England and Wales
the number of Females is greater than that of the
Males, in proportion to the Population of the respective
sexes.

It only remains to add a general abstract of the results
obtained from the various sources to which we have
alludedj and which contains the nearest approximation,
at which we have any certain means of arriving, to the
total numbers of the Insane, Private and Pauper, in
England and Wales, on the 1st of January, 1844.

194

i-i .5

f-S

o oi CO rt cs

t>. to CJ w

O 00 to o »>.

O) -f CO CD

"*< i-H O CO

OO CO CO C<l

'^t

I-H CO C!5

•4

_?i

«£> I-! •* 05 so

t- r-H O O

'Tt* »o OS in

•<*i in ». >— 1

CO IM ■*

Ol CD i-< 1-1

i-( in

r-l

-:»< CO -* ■* tC

o in as <M

•a

O CO O t£> Cv]

CO 05 o «>.

O i-H (N -*

CO to nH ,-1

.-H ^

krt 0» ^ cr

^ O C5

lO CD 1 Cd "*

in IM CO

i-i 1 i-H CO CO OV CO 1

■*

r-l O

»— I

.— 1 1— 1 in to -* CO O

CO lO I CO •-=

05 ». J>. 1

(N 1 1-

Tjl Ol rH 1

7—i

CT>

■^00 to t>. O !>. 05 .

IM CO 1 00 «>. to -* «0

a> 1 r-l CO Oi i-H 1

J>.

■a

lO 00 <M to CO to (N

•^ 1 O ^ CO »^ IM 1 00

IM 1 i-H -5)1 in 05 ^ 1 (M

i—t

in I -* -# t>- CO CO , o

r-J

P-l

I-I CO 00 in !>. ^

rH ' O) <M ^«0 ' I-i

CO 1 to r^ ^ 05 ■* t>.

I-I 1 r-H I-I IM in *>. ' i-<

• -i

' C

• • . .2

:ll

here
rami

m "^ M

olit
;ial
;ew
Co

■e 6 *© t'

<tjW -^ £

1 P.5%^

D
;>

''3'^'^T

Licensed Houses :-

,, Met!

Prov

* "Workhouses and

Single Patients und

County Asylums
Ditto, under Loc
Military and Na\
Bethlem and St.

Other Pnhlir As

co S

o o "^ to

•* °

so-*

00 «

PL|00 M-

m*^ I-I n

^ aj .- <u

ra s

cs.a >^&.

S. 3

J- _ cS cs

<-^

.2-2 2Ph

'^'i'^ a

c ,^ fl .S*
o3 f o ^

Sogr g
^- 'S > ,i 2"o

•5 «4 ii

S^S M)^ ^*

3 S 3 ^-a -=

§ 2 S^l-g
d t*-i .S " ^ "5

- K-S

" '^ "^ 'S -^ «=

5^ rr* ^ ra TO (jN

§ S 52.2 1-^ 3
I— I ja >j o tTjH

S S'

33 Q.

rn 'i* ^
S ^H O

grQ o OJ aT
"-* S 2 2 -=>

,3 aj ^ S

a^zr

3 ,2

*§?s

g^fn^l

r.s

^ 3 S

^ p='

I +3 'C M S i3'

195

IX.

CRIMINAL LUNATICS.

It has been matter of frequent complaint, that Asy- Objections to

1 1 iirz-i'-iTj."- sending Crimi-

lums are made receptacles tor Urimmal Lunatics, in- ^,^^ Lunatics to
eluding all those who are confined under orders from the Asylums.
Secretary of State, or Royal warrants. The objec-
tions urged to their detention in Lunatic Asylums,
and to the County Asylums being requbed to receive
them, apply principally to those who have perpetrated
atrocious crimes, and who are dangerous and a sourde
of annoyance to the other inmates, whose liberty is, in
some cases, abridged, in consequence of the necessity of
providing for the safe custody of the Criminal Lunatics.
In respect to these, the Asylum may be viewed rather
in the light of a Prison than of an Hospital.

Before proceeding further with our observations upon
this subject, it may be convenient to refer shortly to
the leading Enactments under which Insane Persons of
this description are committed to Lunatic Asylums.
These are, the Acts 39 & 40 Geo. 3rd, c. 94, and 3 & 4 Enactments
Yic. c. 54. The first-mentioned Act applies to persons |^j^^[ Lunatics.
" acquitted, on the ground of Insanity, of Treason, Mur-
der, or Felony;" to Persons " indicted and found Insane
at the time of Arraignment ;" to those "brought before
any Criniinal Court to be discharged for want of prosecu-
tion, appearing Insane ;" and to Persons " apprehended
under circumstances denoting a derangement of mind,
and a purpose to commit" an indictable crime. The
Act also provides for the custody of Persons " ap*
o 2

196

Number of Cri-
minal Patients
ia Asylums.

Nature of
crimes.

pearing to be Insane, and endeavouring to gain ad-
mittance to Her Majesty's presence, by intrusion on
any of Her Majesty's Palaces or Places of Residence."
The 3rd & 4th Vic, c. 54, extends the provisions of
the 39th & 40th Geo. 3rd, c. 94, to cases of Misde-
meanour ; and authorises the transmission to Lunatic
Asylums of Persons becoming Insane, while in Prison.
It applies to all persons " confined under sentence of
Death, Transportation, or Imprisonment ;" " or under a
charge of any offence, or for want of Sureties to keep
the Peace, or to answer a criminal charge ; or in conse-
quence of any Summary Conviction, or other than
Civil process." The Act also empowers the Visiting
Justices to make orders of maintenance upon Unions
and Parishes, repealing certain provisions of the for-
mer Act upon that subject. — It has been assumed, in
practice, that the acts above cited are compulsory upon
the visitors of County Asylums, and that they cannot
refuse to receive persons committed under Royal war-
rant.

It will be seen by Schedule I, in Appendix G, (com-
piled from the Parliamentary Return lately printed)
that in April, 1843, there were 224 criminal patients
confined in the several Asylums in this country, and 33
in Gaols. Of the former number of criminals there
were 85 in Bethlem Hospital, leaving 139 distributed
in various County and Private Asylums.

A considerable number of the Patients included in the
above statement were cases of Larceny, and minor
assaults, and other Misdemeanours, as to which com-
paratively little objection existed to their being asso-
ciated with other Patients in Lunatic Asylums. There
were many cases, however, of an atrocious character,
calculated to render the party dangerous, and an object
of dread and disgust to those around him, such as
Murder, Arson, and Unnatural Offences. Of these, as
will be seen by reference to Appendix G, in Schedule II,

197

there were 50 instances in the Public and Private
Asylums, exclusive of those in Bethlem. Amongst
these, is the case of a furious and dangerous Maniac
in the Chester Asylum, admitted in 1835, who had
committed a murder, by strangling, under the most
atrocious circumstances, and whom, in order to pre-
vent him from killing or injuring those around him,
it was found necessary to keep under constant restraint,
both day and night. This man was, and had for some
months been, the only patient under any kind of
restraint in that Asylum.

We believe that care is frequently taken to conceal, Criminality of

T-r^. T n n 1 ' • 1 - Lunatics fre-

from the other Patients, the fact of their associate being quently con-
a Criminal Lunatic. This, however, cannot always be •'^aled from

' "^ other Patients.

effected ; and even were that possible, one objection only
would be removed, to the practice of detaining criminals
in Lunatic Asylums, possessing no proper Wards for that
purpose. The risk of escape calls for arrangements Risk of escape.
more stringent than those required in the case of other
Lunatics. Some consideration, moreover, is due to the
feelings of the relatives of patients, who have reasonable
ground to complain of atrocious criminals being forced
into their society. In reference to this part of the sub-
ject, however, regard must be had to the nature of the
offence committed by each Criminal ; since there are,
without doubt, instances in which it would be hard to
condemn a " Criminal Lunatic " to confinement in a sepa-
rate Ward, or a distinct Institution. These cases, however,
are exceptions, and leave the general objections untouched.
In reference to the subject of Escape, we may mention
the fact which came to our knowledge in the course of one
of our Visits, that a criminal Lunatic had escaped from a
Private Asylum at Plympton for the third time, and had
not been re-taken ; and also that a male patient, committed
by a Magistrate, as a dangerous Lunatic, to a Private
Asylum at Nunkeeling, had escaped three times, had
twice attempted the lives of his Keepers, and once to set

198

Practice at the
Home Ofl5ce.

Mr. Capper's
evidence.

fire to the Asylum ; and that the Proprietor of the Asylum
had applied in vain to the Secretary of State, and to the
Magistrates of the District, for the purpose of his being
removed to a place of safe custody. At Gateshead
Fell Asylum, also, there is a Maniac, who formerly
escaped from the house, murdered his wife and daughter,
and was (after his Trial) re-admitted as a Criminal
Lunatic, and is now generally hand-cuffed, in order to
prevent his again committing murder.

The practice at the Home Office (as we learn from
Mr. Capper's evidence before the Lords* Committee on
Gaols, in 1835) is (upon being applied to in the case of
any person acquitted on the ground of Insanity) to com-
municate with the Visiting Justices, with a view to
ascertain whether there is any Lunatic Asylum in the
County, to which they propose his removal. Mr. Capper
stated that considerable difficulties existed upon the
subject, to which we need not advert. We may men-
tion, however, the fact stated by him, that, as regarded
the County of Middlesex, the Visiting Justices had
remonstrated against Criminal Lunatics being sent from
Newgate to Hanwell, although Middlesex prisoners, on
the ground that the Hanwell Asylum afforded no
security for that class of offenders. Mr. Capper, in his
evidence, adverts also to a class of Criminal Lunatics
of which we have found instances, both in County
and Private Asylums, viz., those who after trial and
acquittal on the ground of Insanity have proved not
to be Insane, or who have become perfectly sane within
a short period after their committal to a Lunatic Asy-
lum, and yet are, "in many cases, too dangerous to
" turn upon the public, having committed crimes of a
" serious character." Mr. Capper suggests that, for
such persons, a particular class should be formed in
Prisons.

We now beg to draw your Lordship's attention
to some observations made by the Lord Chancellor

199

of Ireland, contained in a letter produced and read by Opinion of
Mr. White (Inspector-General of Prisons) to the Lords' lor of Iicland.'
Committee, upon the state of the Lunatic Poor of Ireland,
in 1843. They are as follows: — "Solid objections
exist to Criminal Lunatics being received into District
Asylums, which never were intended for prisons. The
advantages of bringing together all the Criminal Lunatics
under the immediate eye of the Governor (^. e. of the
Richmond Asylum, with which it was proposed to
connect a detached Criminal Lunatic Establishment) is
obvious. Their security could, easily be provided for,
and strangers could be prohibited, from visiting that
Department from motives of curiosity."

We entertain a strong opinion that it is highly desir- Separate care
able that arrangements should be made for the separate Criminar Luna-
care and custody of Criminal Lunatics : and we would ^"^f '"glily 'Jesir-

'' ^ _ able.

submit to your Lordship that, as respects all Criminal
Lunatics who have been charged with serious offences,
and whom it is necessary to detain in custody, it is
desirable that arrangements should be made with one
or more Public Institutions, as Bethlem Hospital, or
that a separate class should be formed in some con-
venient Prison, so as to prevent their association either
with other Prisoners, or the Inmates, generally, of
Lunatic Asylums.

WALES.

We have now brought to a conclusion all the obser- Neglected state
vations which we feel it necessary to make at present ^^^^ Insane at
with regard to the care of Lunatics in England ; but it
is our duty to bring under your Lordship's special con-
sideration the very destitute and neglected state of the
insane within the principality of Wales.

200

With the exception of the small Asylum at Haver-
fordwest (so totally unfit for its purpose) before adverted
to, there was no Asylum throughout the whole of the
Principality until last year, when a House was licensed
for Pauper and Private Patients, in Glamorganshire.*

In 1843 there were in Wales 1177 Pauper Lunatics,
according to the Poor Law Returns recently printed by
the House of Commons.

Of these 1177 Pauper Lunatics, it appears that
thirty-six were in English County Asylums, forty-one in
English Licensed Houses, ninety in Union Workhouses,
and 1010 boarded with their friends and elsewhere. It
has been represented to us that many of the Welsh Luna-
tics, who have been in the English Asylums, have been
very violent, and have been sent to them in a wretched
and most neglected condition. When at Briton Ferry,
we made the inquiries, directed by the Act, as to the
condition of the Paupers on admission, and we were
shown a letter, addressed by a Parish Officer to the
Proprietor of a Licensed House, of which we give a
copy.

" Blaenbwch, I9lh December, 1843.

" Sir, — We have got an Insane Female Pauper of the
Union of Buillht, Breconshire ; she has been so for some
years. Something has took her in her limbs about two
years ago, until she is quite a cripple. I suppose it is
owing to being kept in a close place, having no practice to
walk. Please to write me the lowest you charge per
week."

In illustration of the statements we have received, as
to the deplorable condition in which some of the Pauper
Lunatics of North Wales have been found, and the
necessity of providing an Asylum for them, we may

* We are happy to be enabled to state that an Asylum, for Private
and Pauper Patients, is about to be erected near Denbigh, The county
of Flint has resolved upon uniting with Denbigh for this purpose. Two
other counties of North Wales have decided against a union.

201

mention four cases described in a letter to the Editor of
the North Wales Chronicle, dated 28th October, 1842,
of which we have the permission of the Dean of St.
Asaph to say, that he avowed himself the author. He
states, " I have seen one secured in a dark and loath-
" some shed, lying extended upon straw, (for the space
" did not admit of his standing erect,) in a state of filth
" that I dare not describe. A second was fettered and
" manacled, and basking in the public street^ exposed
" to the rude gaze of the thoughtless passers by. A
" third I have seen led about the streets, and even to
" Church, in the restraint of a strait waistcoat. A
" fourth (I copy from a letter now before me of a Jus-
" tice of one of the Welsh counties), died some time
" ago in the most deplorable state, having been, for
" about fifteen years, chained like a wild beast in an
" out-house."

We have recently received a letter containing import-
ant particulars from the principal Medical Practitioner
at Denbigh, a copy of which is set forth in the note.*

Denbigh, June \4,th, 1844.

* " A few months ago a poor woman, who was under great excite-
•' ment from the mischievous teasings of a crowd of hoys and girls,
" appealed to me in the streets of this town for protection. When I
" got her into my house, and endeavoured, hy kind and conciliatory
" language to soothe her, I found she had been chained by her hus-
" band in a cottage, in a village four miles off, for many weeks. She
" had been in an Asylum in England for some time ; but for want of
' ' knowledge of her native language, no good could be effected.

" I sent her to her friends under proper protection, and she was, I
" lament to say, again consigned to the tender mercies of her husband,
" who, to do him justice, had no other means of preventing the poor
" creature from inflicting iujury upon herself and others. She is now
" more calm, and goes about the country unprotected occasionally.

" A few years ago, a poor girl not above a hundred yards from my
" residence became deranged. From a dislike to send her from
" home, amongst strangers unacquainted with her language and habits,
" she was consigned to the care of a neighbour, who tied her down in
" bed. — She made violent struggles to get away, and, in attempting to
" escape from her keeper, fell down stairs and fractured her head.

" I heard of a man a few months ago, whose family I am acquainted
" with in Carnarvonshire, who was confined in a small room, unshaved

202

Other cases of a similar description were detailed at
a recent meeting of the Committee of Magistrates of the
County of Carnarvon. Among these, that of Griffith
Jones excited painful attention. He had for some time
been confined in a place in which there was no window,
and the smell arising from it was nearly such as to suf-
focate the Medical man who visited him. His bed was
in a most filthy state, and his body covered with vermin;
and he was altogether the image of starvation, despair,
and wretchedness. He is since dead.

In our visits to Wales, and upon other occasions, when
inspecting houses in England, in which Welsh Pauper
Patients were confined, we have made various inquiries
as to the state of the Insane Poor belonging' to the
Principality, and the information which we have
received gives us every reason to believe that there is
but little provision for the support, and still less for the
cure, of these poor people, who are for the most part
placed singly, either with their friends, (who are in the
poorest station of life) or with strangers; a small pittance
only being allowed in each case for their support. So

" and uncleaned for nearly twenty years. He was once a Student of tlie
" University of Oxford.*

" There is now a man in Flint Jail, who was tried the last sessions
" for cutting a poor woman dreadfully with a reaping hook, whilst in a
" state of mania. He had been allowed to ramble about the country
" for months in that state.

" I am acquainted with two or three cases in this town at the
" present time, who are unfit to be at liberty. I had myself a very
" narrow escape some time ago of being killed by an infuriated Idiot,
" who had been tormented by some boys, and who threw a paving-
" stone at my head as I was passing by.

" The state of the Welsh Lunatic, in general, is most pitiable and
" miserable, — with no place of protection in his own country ; and the
" only alternative is an English Asylum, where no real good can be
" effected, and that at an enormous expense to his parish or his friends.

" It is to be hoped that the Legislature will throw its protection over
" him, as I fear his own Country will not without compulsion."
(Siffned) " R. LLOYD WILLIAMS, Surgeon."

* All the other persons alluded to, were Parish Paupers.

203

strongly are we impressed with the necessity of remedy-
ing these evils, that we have directed some Members of
our Board, who are about to visit the districts bordering
on Wales, to make special inquiries, in reference to the
general condition of the Insane throughout the Princi-
pality, and we feel it our duty to bring distinctly under
your Lordship's notice the fact that Wales, containing
no less than 1177 Pauper Lunatics, has at present
within its limits only one house Licensed to receive 36
Insane Pauper Patients, in addition to the Asylum at
Haverfordwest, upon which it has been our duty so
strongly to animadvert.

ASHLEY, (Chaieman).

SEYMOUR.

R. VERNON SMITH.

J. HANCOCK HALL.

R. W. S. LUTWIDGE.

R. GORDON.

THOMAS TURNER.

FRANCIS BISSET HAWKINS.

B. W. PROCTER.

J. R. GO WEN.

H. H. SOUTHEY.

J. W. MYLNE.

JOHN BARNEBY.

W. H. SYKES.

THOMAS WATERFIELD.

J. C. PRICHARD.

J. R. HUME.

204

SUGGESTIONS FOR THE AMENDMENT OF THE LAW.

In the expectation that the Law, as it regards Lunacy,
will shortly be subjected to revision. We trust that
we shall not be thought to have exceeded the limit of
our duties in offering the following suggestions to your

Lordship.

1.
That there be provided for the Insane Poor of every
County some proper and convenient Hospital or Hos-
pitals for the reception of all recent cases.
2.
That the provisions of the Law, enabling Counties to
unite for the formation of Asylums, be extended to parts
of Counties, Towns, and places with separate jurisdic-
tions ; and also to the union of Counties and Districts
having no Asylums with others possessing such Institu-
tions.

That the 15th section of the Act 9 Geo. IV. c.40,
be amended, by enabling a majority, being not less than
two-thirds of the Justices of the Peace present at any
General or Quarter Sessions, to direct or authorise
tenants at rack-rent to detain out of their rent one-half
of the full amount of all or any rates hereafter to be
levied for building, enlarging, and repairing County
Asylums, or in reference thereto.
4.

That in any County Asylum or Hospital hereafter
to be erected, into which curable Lunatics (either alone^
or together with incurable Patients,) shall be received,
the number of Patients shaU not exceed 230 in the
whole. (See pp. 23, 24.)
5.

That some provision be made for the removal, from
time to time, of Incurable Paupers from County Asy-
lums, in order to make room for such as are curable.

205

That in the more populous Counties, such as Middle-
sex and Lancashire, separate receptacles be established
for Chronic cases ; to be conducted in a manner adapted
to the wants of the Patients, but upon a less expensive
scale than the present County Asylums.
7.

That if it be deemed a matter of necessity, under
present circumstances, to confine some incurable Pauper
Lunatics elsewhere than in receptacles expressly esta-
blished for the purpose, they shall be kept, not in all
Workhouses indiscriminately, but in some one specified
Workhouse, or part of a Workhouse, within each dis-
trict ; and that every such Workhouse, or part of a
Workhouse, be properly adapted and exclusively appro-
priated to the reception of Lunatics, and be regularly
inspected by competent Visitors, and have regular Medi-
cal Officers.

That all Pauper Lunatics, confined elsewhere than in
Asylums, be periodically visited ; and that periodical
Reports be made upon their condition.
9.

That the Sites, Plans, and Estimates for every County
Asylum hereafter to be erected, be referred to some
Board or authority, constituted for the visitation and
supervision of Lunatics, for the purpose of receiving
suggestions, previously to the final adoption thereof by
the Magistrates.

10.

That the Orders and Medical Certificates for the
admission of Pauper Patients into any Asylum, or other
place of confinement, be the same as are nov? required
for their admission into Licensed Houses, and that no
order be given unless the party signing has previously,
seen the Patient.*

That the Orders and Medical Certificates for the

* At present, a Pauper is sent to an Asylum on one Certificate, and
it does not appear necessary that the Magistrate, or other person signing
the order for his confinement, should previously see the Patient.

206

admission of Private Patients into any Asylum, or other
place of confinement, be the same as are now required
for their admission into Licensed Houses. (See p. 163.)

12.

That no person certifying as to a Patient's Insanity,
sign an order for his confinement.*

13.

That, with a view, amongst other things, to the for-
mation of a complete Register of the Insane, notice of
the admission, discharge, and death of every certified
Patient, Private as well as Pauper, (excepting only those
Patients of whom " Private Returns" ought to be made),
be sent to the Metropolitan Board, within two days after
every such admission, discharge, and death; and that
in every notice of Admission, the day on which the
Patient was received shall be stated, such day also to
be endorsed upon the original order, and certificates, f

14.
That every County and Public Asylum or Hospital
shall have a resident Medical Ofl&cer.

15. '

That the Orders and Medical Certificates for the
admission of Patients be a sufficient authority for
re-taking them, in case of escape, at any time within
eight days after such escape.

16.

That all Asylums and Hospitals for the Insane be
subject to official visitation. (See page 33.)

17.

That the Official Visitors have power, at their discre-

* In one or two cases, we have found that the brother or father of
the Patient, being a medical man, has signed the order for confinement,
and also certified as to the Lunacy.

i" This will also facilitate the examination of the orders and certifi-
cates upon the admission of private Patients into Asylums, and dispense
with the necessity of referring to the Register of admissions in order to
ascertain that the Patient was received within the period limited by law

207

tion, to give an order for the admission of any relation,
trustee, or friend, to visit a certified Patient, wherever
confined. (See page 75.)

18.

That the Official Visitors have power to fix and alter
the Dietary of Pauper Patients in all Lunatic Asylums.
(See page 49.)

19.

That the Lord Chancellor be empowered, upon the
representation of the Board of Metropolitan Com-
missioners, to suspend the Licence of any House
licensed for the reception of the Insane.
20.

That it be lawful for the Proprietor or Superintendent
of an Asylum, with the permission, in writing, of the
Official Visitors, to take or send a Patient to any speci-
fied place, for a limited time, for the benefit of his
health.

21.

That, in the event of any Proprietor quitting a
Licensed House for another licensed to him, it shall be
lawful for him, with the previous permission, in writing,
of the Official Visitors, to transfer his Patients from
the one to the other, without fresh Orders and Medical
Certificates,*

22.

That Licences be granted, in all cases, to the Pro-
prietors of Licensed Houses, and not, as now, in some
instances, to the Resident Superintendents.
23.

That no dangerous Lunatic be removed from any
Licensed House against the advice of the Medical
Attendant of the House, without the previous sanction
of the Official Visitors. (See page 171.)

24.
That a full statement be published, annually, by

* The want of such a provision occasioned considerable inconve-
nience in a case which was brought under the notice of the Commis-
sioners.

208

every County Asylum, of all receipts and disburse-
ments; also of the property of the Asylum, the sources
and amount of Income, and the application of the same.

(See page 26).

25.
That in all Asylums, Public and Private, Registers
and Medical Records be required to be kept, in a spe-
cified and uniform shape ; and that annual statements
of admissions and discharges, in a form to be pre-
scribed, be made up to the 31st of December in each
year, and transmitted to the Metropolitan Board. (See
page 179.)

The following, amongst other suggestions, have been
received from the Clerk* to the Visitors of a County
Asylum, who is also Clerk to the Board of Guardians,
and are submitted for your Lordship's consideration.

That the order of Commitment to the County Asy-
lum should be made without requiring any adjudication
of Settlement, so far as the Asylum is concerned.

That the Union to which the Pauper is chargeable,
should be liable to the weekly payments for Pauper
LunaticSj until an order of payment shall have been
made by Justices upon another District or Parish, upon
application of the Board of Guardians.

* EXTRACT FROM A LETTER RELATIVE TO THESE
SUGGESTIONS.
" The reason for these alterations arises from the difficulty too fre-
quently experienced in obtaining the requisite evidence for the Justices
to act upon, at the time the Patient is required to be sent to the Asy-
lum ; and having recourse to the other provisions of the Statute is
attended with many difficulties, as will appear from the cases decided
by the Court of Queen's Bench, not one of which, I believe, has
stood the test of a Judicial scrutiny, the Union from which a Patient
is sent ought, in common fairness, to be chargeable with the expenses,
until the place of legal settlement is found out— and I am of opinion
that the practice should be assimilated to that under the Poor Law.

A. Pauper is admitted into the Workhouse from the parish in which

he last resided, and it is for that parish to get rid of the burthen by
finding out the place of his legal settlement."

APPENDIX A.

COUNTY ASYLUMS,

Erected under the Acts 48 George III. c. 96, and 9 George IV. c. 40.

Beds.

(Bedford)
Chester

(Chester)

CORNWAI,!, .

(Bodmin) . .
Dorset . .

(Foreton, near

Dorchester) . .
Gloucester . .

(Gloucester)
Kent ....

(Barming Heath,

near Maidstone)
Lancaster . . .

(Lancaster Moor)
Leicester . . .

(Leicester)
Middlesex .

(Hanwell)

Norfolk . . .
(Thorpe, near
Norwich) . .

Notts ....
(Nottingham) .

Stafford . . .
(Stafford) . .

Suffolk . . .
(Melton, near
Woodbridge)

Surrey ....
(Springfield, near
Wandsworth) .

York West Riding
(Wakefield) . .

Superintendent.

J. Harris, Surgeon.
J. Leete, Surgeon.
D. F. Tyerman, M.D.

G. P. Button, M.D. .

S. Hitch, M.D. . . .
G. S. Poynder, Surgeon,

S. Gaskell, Surgeon . .
H. F. Prosser, Surgeon.

— Godwin, (Governor)

Visiting- ? J. Conolly,
Physician S M.D.

House- P'm'I;,"^'
Surgeons ^^p^^^^j^p

Ehenezer Owen . . .

T. Powell, Surgeon.
Jas. Wilkesj Surgeon.
J. Kirkman, M.D.

S. Hill, Surgeon. .

C. C. Corsellis, M.D.

Date of
opening.

1812

1829
1820

1832

1823
1833

1816
1837

1831

1814

1812
1818
1829

1841

1818

Weekly charge
for Paupers.

s. d.
(0 7 6
Out County.
8 6
(b)4 1
Out County.
10
5 6
Non- Contri-
butory Dist
10 6
(a) 7

(a) 9
(a) 8 6

(a) 6

(b)8 6

Out County.

(a) 7 7

Out County.

(a) 5 3

Out County.
8
(a) 8

(a) 7

(a) 5 10
Out County.
8 10
(a) 9

(a) 7

Numbers, Jan. 1, 1844.

Private. Pauper. Total.

Totals

68
27

52
62

245

139
155
133

107

*975

164

125
183
206

382
433

4155

189

257

249

611

104

131

139
164
153

107

975

164

177
245
213

382
433

4400

(a) Including clothes.

(b) Not including clothes.
P

* Sept, 30, 1843

210

ASYLUMS MADE, BY LOCAL ACTS, SUBJECT TO THE PROVISIONS
OF 9 GEORGE IV. c. 40.

Superintendent.

Date of
Opening.

Weekly

Charge for

Paupers.

Number

1st Jan., 1844,

(Paupers.)

St. Peter's Hospital, Bristol.

County of Pembroke, Haverfordwest.
Workhouse, Kingston-upon-HulL*

— Brady, Surg, -j
G. Hampson.

Incorporat-
ed 1696. 1

• • •

72
17

Total . . .1

MILITARY AND NAVAL HOSPITALS.

Hospital.

Nature.

Principal Medical Officer.

Numbers 1st January, 1844. |

Commissioned
Officers.

Non-Commissioned
Officers and Pri-
vates.

Total.

Fort Clarence, Chatham
Haslar Hospital, Gosport

Military
Naval

Andrew Smith, M.D.
Sir W. Burnet, M. D.,

49
69

70
98

Total ...

168

BETHLEM AND ST. LUKE'S HOSPITALS.

Where situate.

Steward.

Numbers, Jan. 1, 1844.

Curable.

Incurables.

Criminals.

Bethlem Hospital

St. liuke's Hospital . •

St. George's Fields . "
Old Street, City Road

Mr. Nicholls .
Mr. Stinton .

181
93

84
84

-'■■- 1

Totals . . 1

274 1 168

OTHER PUBLIC ASYLUMS AND HOSPITALS.
Supported wholly, or in part, by Charitable Contributions.

Name of Asylum.

Superintendent.

Date of
opening.

Weekly
charge for
Paupers.

Numbers,
Jan. 1, 1844.

Pri-
vate

47
25
30

37
36

t66

105

536

Pau-
per.

181

52
343

Tot.

103

73
36
■23)
66
41'

157
98

879

Exeter . .
Guy!s Hospl.
Lincoln . .

Liverpool
Manchester ,
Northampton
Norwich .
Oxford . .
(Headington)

York . .
Ditto . .

St. Thomas's ....
Lunatic Ward ....
Lunatic Asylum . . .

Lunatic Asylum . . .
Lunatic Asylum .
General Lunatic Asylum
Bethel Hospital . . .
Warneford Asylum .

Asylum'.

Friends' Retreat . . .

Luke Ponsford, Surgeon.

W. Graham . . . .
House Surgeon.

G.Tyrrell

T. 0. Prichard, M.D. .
— King. .....

F. T. Wintle, M.D. . .

S. Alderson, Surgeon.
J. Thurnam, M. D. . .

1801
.1820

1792

1838
1713
1826

1777
1796

• s. d.
' 15

(b) 10

12
(b) 9

f(a)M.7 6
\Fem. 6 6

Totals . .

(a) Including clothes. (b) Not including clothes.

* It has recently come to the knowledge of the Commissioners that this Workhouse is, by a Local
Act, (5 Geo. IV. c. 1.3,) constituted an Asylum, subject to the County Asylum Acts.

f It is believed that some of these are maintained p.artly at the charge of Parishes.

211

METRO!*OLITAN LICENSED HOUSES.
RECEIVING PRIVATE PATIENTS ONLY.

PEOPRIETOR.

Ayres, William (Surgeon)

Bell, Robert

Birkett, Richard

Bradbury, Mrs. Mary

Burrow, Miss

Bush, John (Surgeon)

Cole, James

*Co8tello, W. B., M.D

Diamond, W. B. (Surgeon) . . . .

Fleming, Mrs. Mary

Haines, W. F. (Surgeon)

*Homer and Co., Edward

Jackson, John Thompson

Kerr, Alfred George (Surgeon) . . . .

Magnall, Mrs. Martha

Monro, E. T., M.D

Oxley, William (Surgeon)

Parkin, John (Surgeon)

Philp, F. R. M.D. and Finch, C. H.M. .

Pierce, Miss Mary Ann

Roy, D. T, (Surgeon)

*Sloman, Harriet, Mrs

Smith, William

Steward, J. B., M.D., and Daniel, G.W. \
(Surgeon) . .•....,/
Stilwell, Arthur (Surgeon) and W.

Sutherland, A. R., M.D

Symmons, Eliza, Mrs. and Co. . . ,

Talfourd, Ann, Mrs

Tow, James

Williams, Walter Davis, M.D. . . .

Wood, Susan, Mrs

Warburton, John, M.D

HOUSE, AND WHERE SITUATE.

Mare Street, Hackney . . .
Manor House, Chiswick . . .
Northumberland House, Stoke Newingti
Earl's Court House, Old Brompton
Grove House, Stoke Newington Green
Retreat, Clapham .....
Dartmouth House, Lewisham ,
Wyke House, Sion Hill, Brentford
Western House, St. Pancras
Warwick House, Fulham Road
Harefield Park, Uxbridge . .
Lawp House, Hanwell . . .
Turnham Green Terrace . .
17, Pembroke Square, Kensington

Hanwell >

Brook House, Upper Clapton
London Retreat, Hackney .
Manor Cottage, King's Road, Chelsea
Kensington House, Kensington
Beaufort House, Fulham . .
Hope House, Brook Green .
Oak Tree Cottage, Harrow •
Lampton House, Hounslow

Southall Park

Moor Croft House, Hillingdon
Blacklands House, Chelsea . ,
Otto House, Fulham . . • .
Cowper House, Old Brompton .
Normand House, Fulham
Althorpe House, Battersea .
Pembroke House, Hackney
Elm Grove House, Hanwell
Whitmore House, Hoxton . .

No. of
Patients,

Jan. 1,

1844.

Private.

5
16
46
26
13
12
13

13
5
2

2
2
5

34
28
15
55
5

30
30
22
39
18
12
95
7
41

RECEIVING PAUPERS.

Weekly Charge
for Paupers.t

Private.

Pauper.

Armstrong, Peter

Lee, Henry Boyle (Surgeon)
Warburton, John, M.D. . .

Peckham House ....
Hoxton House, Hoxton . .
Bethnal Green ....

s. d.

9 8i

226

203

315
336

* House Licensed since 1 Jan. 1844.

f For maintenance, medicine, and clothing.

212

PROVINCIAL LICENSED HOUSES.

RECEIVING PRIVATE PATIENTS ONLY-

PROPRIETOR.

Beds. .
Bocks.
Devon
Dorset

Esses . .
Gloucester

Hants
Herts .
Kent .

Lancaste

Leicester

Lincoln .
Norfolk ,

Northumberland
Oxon .

Somehset .

Stafford .
Suffolk .
Surrey

Sussex .

Warwick .

Wilts . .
York, E. R.

Do. W. R.

Do. City & Subs.

Harris, J. (Surgeon) . . .
Horner and Harper, Messrs.

Rich, James (Surgeon) . . .

Mercer, J

Sj'mes, W. (Surgeon) . .

Allen, M. (M.D.) . . . .

ConoUy, W. (M.D.) . . .

Eyre, T. D

Fox, H. H. (M.D.) , . . .

Mules, C

Taylor, M.( Mrs.)

Burnet, C. M. (Surgeon) . .
Smith, James (Surgeon) . .

Harmer, J .

Newington, J. N. (Surgeon). .

Edwards, E

Haigh, E. (Mrs.)

Lomas, G

Kershaw, P

Owen, J

Squires, Richard (Surgeon)

Benfield, C

Willis, F. (M.D.) . . . .
Nichols and Watson (Messrs) .
Pedgrift, Robert (Surgeon) . .
Steele, H. (Surgeon) . . . .
Wright, W.( M.D. )& Dalrym-I

pie & Cross, Messrs. (Surg.) /
Keenlyside, J. W. . . .

Batt, E. A. (Surgeon) . . .
Mallam, Richard (Surgeon)
Fox, F. K. (M.D.) and C. \

J. (M.D) . . . . /
Langworthy, R. A. (M.D.)
Baliewell, G. S. (M.D) . . .
Woody, Alice (Mrs.) . . .
Chevallier, J. Rev. (M.D.) .

King, Jane (Mrs.)

Chapman, (SirJ. )&Co.(Surgs.)
Stedman, Jas. (M.D.), & others
King, W. (M.D.) . .
Newington, C. (Surgeon)
Do. do. .

Brown, Henry (Surgeon)
Boddington, G. (Surgeon)
Burman, H. (M.D) . .
Ogilvie, G. S. (Surgeon)
AUanson, W. (Surgeon)
Atkinson, J. (Surgeon) .
Durham and Haigh, (Messrs
Hodgson, H. B. (Surgeon)
Kitching, J. (Surgeon) .
Smith (Surgeon), Smith, P

(M.D.)

Allis, T

Beleombe, H. S. (M.D.)
Dawson, W. . . " . .
Tose, E. (Mrs.) . . .

Springfield House, Kempston, Bedford
Denham P.trk, near Uxbridge . .
Ford House, Church Stanton . . .
Portland House, Halstock ....

Cranboume

High Beach, near Epping . ,
Castleton House, Charlton Kings.

Cheltenham ....
Upper Bath Road, Bristol . .
Northwoods, Winterboume . . .
Ridgeway House, near Bristol . . .
Whitehall House, St. George's, Bristol
Westbrook House, Alton ....
Hadham Palace, Much Hadham . .

Hawkhurst

Goudhurst

Blakeley House, near Manchester .
Heath Green, Newton, do. . . .

Clifton Hall, do

Billington Whalley, near Tew . .
Brook Villa, West Derby, Liverpool .
Walton Lodge, near Liverpool . .
Wigston House, Great Wigston . .
Shillingthorpe House, near Stamford
Heigham Hall, near Norwich . . .

Loddon

Stoke Ferry

Heigham Retreat, near Norwich . .

Belle Grove House, Newcastle-on-Tyne

Witney . . . *

Hook Norton

Brislington House, near Bristol . .

Longwood House, Ashton, do. . .

Oulton House, Stone

Moat House, Tamworth ....
A spall Hall, near Debenham ...
Wherstead Road, Ipswich ....
Great Foster House, Egbam . . .
Lea Pale House, Stoke, near Guildford

Ringmer, near Lewes

Asj'lum, Ticehurst "I
Highlands, do. J

Henley in Arden

Driffold House, Sutton Coldfield . .

Henley in Arden

Calne

Retreat, Rillington, near New Malton
Weaverthorpe, near Sledmere . .
Field Head House, Wakefield . .
Acomb House, near York . . . . .
Painthorpe House, near Wakefield . ,

Castleton Lodge, near Leeds . . . ,

Osbaldwick, near York

Clifton House, York

St. Maurice House, York . . . .
Terrace House, Osbaldwick , . . .

213

PROVINCIAL LICENSED HOUSES.
RECEIVING PAUPERS.

PROPRIETOR.

Derby
Devon

Durham

Essex . .
Gloucester .

Hant ; . .

Hereford

Kent . .
Lancaster
Northumberland
OxoN . . .
Salop . .

somkrset . .

Stafford ,

Suffolk

Warwick

Wilts

•!

Worcester
York, N. R
Do. E.R. .|

Do. W. R.

Brjgstocke, (M.D.) . . .

Lancaster, John

Langwoithy, R. C. (Surgeon)

Eales, J., and Sister . .
Glenton, F. and P. (Surgeon)
Gowland, Jacob ....

Kent, S

Wilkinson, J. E

Tomkins, J. (Surgeon) . .
Bompas, G. G. (M.D.) . .

lies, A

Middleton, H. (Mrs.) . . .
Riches (Surgeon) ....
Scales, G. J. (Surgeon) . .
Twynam, J. TM.D.) . . .
Gilliland, J. (Surgeon) . .
Millard, S. (Surgeon) . . .

Rix, Jane (Mrs.) ....

Mott

Smith, N. (M; D.) and Mc"!

Intosh, D. (M.D.) . . . /
MaUam, Richard (Surgeon) .
Gough, (Surgeon, Governor of "1

House of Industry) . . /
Jacob, James

Gillett, W. E. (Surgeon) .

Terry, Stephen (Surgeon)

Rowley, T, (M.D.) . .

Shaw, James (Surgeon) .

Gibbs, M. (Mrs.) . . .

Lewis (Messrs.) . . .

Finch, W. (M.D.) . .

Finch.W. C. (M.D.). .

Langworthy, C. C. (M.D.)
Phillips, T. (Surgeon)

Spencer, C. F

Willett, R

Ricketts and Hastings, (Messrs)

Surgeons

Martin, James

Beall, Jos

Casson, Richard (Surgeon) .

Gofton, Robert

Hornby, B. (Surgeon) . .
Taylor, C. A. (Miss) ; . .

Taylor, Isaac

Walker and Matterson, "]
(Messrs.) Surgeons . . J

Green Hill House

Workhouse, Stoke Damere],De- "1

vonport j

Plympton House, Plympton St. 1

Mary J

West Auckland

Bensham, near Gateshead .

Wreckenton, do

Gateshead Fell

Dunston Lodge, Whickham .
Maldon Lane, Witham .
Fishponds, Stapleton, near Bristol

Fairford

Grove Place, Nursling . . . ,
House of Industry, Carisbrooke ,
Hilsea Asylum, Portsea Island .
Lainston House, Winchester .

Hereford

Whitechuich, near Ross .
West Mailing Place, West Mai- "1

ling J

Haydock Lodge, Winwick . .
Newcastle-on-Tyne, Lunatic T

Asylum J

Hook Norton

Morda, Oswestry • • , . .

House of Industry, Kingsland, "1
Shrewsbury J

Fairwater House, Staplegrove, 1
near Taunton .... J

Bail brook House, Bath Easton .

Sandfield, Lichfield . .

Belle Vue House, Ipswich

Haugh House, Packwood .

Duddeston Hal], near Birmingham

Laverstock House, Salisbury . .

Fisherton House, Fisherton, 1
Auger J

Kingsdown House, Box . . .

Belle Vue House, Devizes . .

Fontbill GifFord, Hindon . . .

Fiddington House, Market La- |
vington J

Droitwich

Gate Helmsey, near York . ,
Moo Cottage, Nunkeeling, near "1
Brandsburton .... J
Hull and East Riding Refuge .

Southcoates, Hull

Dunnington, near York . . .

Hessle, near Hull

Acomb, near York

Heworth, near York . . .

Weekly
Charge for
Paupers.

(t)

(b) 10 6

(b)
(a)

6 to 7
8

7 to 8

8
(a) 8

10
8 to 9

(a)

S 9 to 9 6
9
(a) 10 to 12
(a) 10

m. t.

(a) 9/6 9

(b)8/6 to 9
2 6t

(b) 6 to 10
(b) (a)

8 9
(b) 9 (a)10

(a) 10

(a) 7/6 to 8

8 to 9

(a)

(a) 8
8

(a) 9

(b) 8

(b)
(b)
(a)

8
8
5 to 9
8

b) 8/6m.8f.
8/6m
7/6f.

(b) 8/6m. X

JGlamorgan I Leach, R. V. (Surgeon)

WALES.
I Brilton Ferry, near Swansea |

1 I 2

(b) Not including clothes. (a) Including clothes. * Same as for O'jt Couity Paupers at County Asyim.

■f Estimated weekly cost.

APPENDI};: B.

COUNTY ASYLUMS.

ACCOMMODATION AND COST OF ERECTION.

♦

'BEBYOKD.— Opened August, 1S12.— Pauper.

Land 9 Acres.

Cost . . . . . Total Cost of Buildings, Furnishing, and

Land, 20,500/.
Accommodation . 90 Males, 90 Females. Total, 180.

Average Cost per head, 114/.

CHESTER. — Opened August, 1829. — Private and Pauper.

Land . . . . 10|^ Acres.

Cost .... Total Cost of Buildings and Land, &c., origi-
naUy about 28,000/.

Accommodation . Originally built for 96 ; viz. — 10 Male and
10 Female Private Patients, and 38 Males and 38 Female
Paupers, to each of whom was assigned a separate Sleeping Room,

The Sleeping Rooms in the Pauper Galleries are 10 ft. by 8 ft,,
and from 11 ft. 3 in. to 12 ft. in height; and two Beds are now,
for the most part, placed in each Room, affording present accom-
modation for 152.

Average Cost per head to County. — Calculated on first Cost of Erec-
tion and original Accommodation . . £292

■ on present Accommodation . . i6184

215

CORNWALL.— Opened IS20.— Private and Pauper.

Land. — Acres, presented by the Corporation of Bodmin.
Cost of Buildings, not including FurnisMng :

Original Building .... £15,000
New ditto • 3,780

Total to present time . . . £18,780

Accommodation . , Original part . 112

„ „ Additional Buildings 60

Total, Pauper, 129 ; Private, 43 . . 172

Average Cost per head : On first Accommodation . . £134
„ „ On present Accommodation . £109

DOUBET.— Opened August 1st, IS32.— Pauper.

Land . . • 8| Acres. — Land, with original House, pre-
sented hy F. J. Browne, Esq., who also vested 4000/. in the
Funds, the Dividends to he appHed towards the Annual Charges
of the Estahhshment.
Cost of Building . . . ' . . £13,156
Furnishing .... 1,561

Total £14,717

Accommodation . 51 Males, 62 Females. Total, 113.
Amount of Subscriptions ;. . . . £3,155
Defrayed by County . . . . 11,562

£14,717

Average Cost per head . On total Outlay, £130
„ „ Borne by County, £102

216

QLOV CENTER.— Opened 2^th July, IS23.— Private and Pauper,

Land . . Original Purchase . 7 Acres for £1,660

Building, &c. First Cost of BuUding £38,500

Cost . . „ Fittings 2,696 7

■ 41,196 7

Total first Cost . . . £42,856 7

Males. Females. Total.
Original Accommodation . Private .30 30 60

„ . Pauper . 30 30 60

Total . 60 60 120

First Cost per head . . . £357

How defrayed (as well First Cost, as of Additions) : —

^-jj by Subscription Fund, or Charitable Institution.

U » County

f of Gloucester, by Rate.

¥V " City

Additional Land . . Second Purchase . 7 Acres for £1,250
„ . . Third Ditto . . | „ 450

N.B. — Ten Acres also Rented.
Total Cost to present Time: —

£1,700

Buildings, about ....

£44,000

Furniture, Fittings, and Apparatus . .

4,000

Land . . . . .

3,360

Total . . .

£51,360

Males.

' Females. Total.

Present Accommodation . Private . 32

39 71

„ „ . Pauper . 95

95 190

Total . 127

134 261

Total Cost of Asylum, defrayed by —

Subscription Funds

£20,544

County ......

28,248

City

2,568

£51,360

217

Average Cost per head for Paupers borne by County and City, 162/.
The sum annually paid by the County and Subscribers for
Repairs and Alterations is about 800/., ^^ of which is paid by the
Subscribers.

KENT. — Opened \st January, \2iZZ.— Pauper.

Land . . 37 Acres . . 6,000/.
Total Cost to present Time, of Buildings, Furniture, and

Land ....

. 64,056/.

Males. Females. Total.

Accommodation . Wards

. 137 137

274

„ Injfirmaries

13 13

Total .

. 150 150

300

^ . - rMales
In smgle rooms < ^

I. Females

. 102

204

Average Cost per Head .

. 213/.

Details of Cost of Asylum : —

Original Buildings, Walls,

&c. (about) . £35,000

Land (37 Acres)

6,000

Fiu-nishing, Apparatus, Baths, &c. . .

9,000

Hospitals

2,056

New Wings

. i

12,000

Total as above

£64,056

LANCASTER.— OjoeTzec/ 2m July, 12>IQ.— Pauper.
Land . . . .15 Acres.
Of this Land Five Acres, first purchased, are within the Boundary
Wall, about one-fourth being covered by Buildings. The remaining
Ten Acres are cultivated as a Farm. They are separated from
the Asylum by a public road, and the ground is swampy.

Thirty Acres from the adjoining Moor have been recently
purchased under the powers of a local Act obtained in 1843.

218

Total Cost of Asylum to 23rd March 1843 :—

Building . . . £91,848 11 3

FurnisMng . . . 5,487 9 3

Repairs and Sundries . 2,232 12 3

15 Acres of Land . . 1,127 4

Total Charge to County £100,695 16
Accommodation . No. of Beds in Apartments

/Males 295
\Females 298

Total of Beds in Apartments

Of these there are in Single Rooms .

** Douhle-bedded

" Three Beds each

•* Four "

" Five

" Six

" Twelve "

" Thirteen "

" Fourteen "

" Fifteen "

" Sixteen "

. " Nineteen "

*• Twenty-one "

" Thirty-one "

593

Males.

4
20

36
26
14

Females.

56
42

10
12

15
32

38 —

— 21

— 31

Total Beds . . . 295 298

Total No. of Rooms . . 126 106

Average Cost per head, 170?.
N.B. — The actual numher of Patients for whom accommodation is
provided is ahout 620.

219

LEICESTER.— Oj»ewec/i»f«y 10, 1S37. —Private and Pauper.

Land ... 8^ Acres.

First Cost of Asylum : — Bxiildings, Fences, Plant-
ing, Wells, Pipes and Water-works, Ventilation
and Warming, Roads, &c £16,893 12

Furnishing and Baths . . . . 2,166 11 3

Land . . 2,070 10

Total .... £21,130 13 3
How defrayed: — Donations and Subscriptions,

with Proceeds of Old Institution, Buildings, and

Funded Property £7,375 3 5

Charge on County Rate .... 13,755 9 10

Total as above . . .£21,130 13 3

Males. Females. Total.
First Accommodation. — In single Sleeping rooms 28 28 56
Dormitories,6 to 10 Beds each . . 24 24 48

52 52 104

Average Cost per head. Private and Pauper . . 203/.

Cost of additional Buildings and Furniture, about . 6,500/.

Total Cost of Asylum to present time, about . . 27,630/.

Present accommodation . 76 Males, 76 Females. Total 152.

Average Cost per head, about . . 180/. — This is calculated
upon the entire outlay and total accommodation. Assuming the
accommodation for Paupers to be equivalent to their actual
number on 1st January, 1844, viz. 104, and charging the
County with the Cost of the additional Buildings, the average Cost
per head to the County for Paupers will be 194/.

MIDDLESEX.
Hanwell. — Opened I6tk May, 1831. — Pauper.
Land, 53 Acres.

The original Cost appears to have been 124,456/. 14«. M.y out of
which the following Payments were made : —

220

For 44 Acres of Land £10,925

For the original Buildings . . . . 77,271 10

For Furniture, &c 8,806 16

The additional Buildings erected in 1837 appear to have cost

20,000/.
We have not obtained the particulars of the costs of this Asylum,
but were informed by the Accountant that it has amounted to
160,000/. This smn does not include 36,000/., which has been
also paid in different annual sums by the County since the 9th of
July 1835, for Furniture, Fittings, and Labour about the Asylum,
and which now annually amounts to about 4,000/., and is exclu-
sive of what is paid by the Parishes. The sums which appear to
have been paid on this accoimt in the year 1843, seem to have
amounted to 6,637/. 12^.
Accommodation . . 1,000 Patients, Male and Female.
Average Cost per head . 160/.

NORFOLK.— Ojoewerf 18^^ May, ISU.— Pauper.

Land . . 4^ Acres.

Cost of Asylum to present time : Building, Fm-nishing, and Land,

(say) 50,000/.
Accommodation . . . . . Males 110 — Females 110. —

Total 220.
Average Cost per head ... 227/.

NOTTINGHAM.

Land 8 Acres.

Total Cost of Asylmn to present time : —

Buildings and Furniture, Apparatus, &c., about £34,000
Land, Planting, &c 2,800

Total £36,800

towards which, about 6,800/. appears to have been contributed
in the shape of legacies, benefactions, and parochial collections.

221

Present Accommodation . Males 85 — Females 85. — Total 170.

Averao-e Cost per head . . 220^. — This is estimated on the total
outlay and amount of accommodation. Assuming the Asylum to
afford accommodation, according to the existing arrangement, for
125 Paupers, the number 1st Jan, 1844, and 30,000/. as the total
outlay borne by the county, the average cost per head for Paupers
will be 240/.

STAFFORD. — Opened 1st October, 1818. — Private and Pauper.

Land 30 Acres.

Cost of Erection and original Accommodation : — The total original
cost of Land, Buildings, and Furniture, appears to have been
about 36,500/. ; whilst the Asylum was calculated to accommo-
date 120 Patients only.

Present Accommodation — 250 Males and Females, viz. about 65
private Patients, and 185 Paupers. Much additional accommodo-
tion for Paupers has been obtained by converting the Gralleries,
by means of folding partitions, into Dormitories. The outlay on
account of additions and improvements cannot be stated.

SUFFOLK. — Opened \st Jan., 1829. — Almost exclusively Pauper.
Land 30^ Acres.

Cost of Buildings, Land, «fec. —

Purchase of House of Industry and Land . . ^8,000

Expense of conversion into an Asylum, Furnishing, &c. 22,000

Extension of Wings, &c. . . . . say 2,000

Total .... £32,000

222

Accommodation .... 90 Males — 90 Females. — Total 180.

Average Cost per head . 177/.

N.B. — Additions and improvements are in progress, by which

accommodation will be made for 30 more Patients. At present

the Asylima is much crowded.

SURREY.— Ojoewerf Utk June, ISil.— Pauper.

Land 97 Acres.

Cost of Buildings, Land, <fec. —

Buildings £67,467 1 10

Furnishing, &c., and preliminary expenses 7,514 19 3

Land, &c . 8,985 9 5

Total . . £85,366 19 1

Accommodation . . . Males 180 — ^Females 180. — Total 360.
Average Cost per head . 237/.

YORKSHIRE, W. RIDING.— (Wakefield.)

Land. — In addition to Pleasure Garden and Grounds, 40 acres cul-
tivated as Farm and Kitchen Garden.
Accommodation .... Originally built for 150

Additional Wings 154

304
Actual Numbers accommodated . . 420

Total Cost of Land £8,846

Buildings, Fittings, &c 38,000

£46,846
Average Cost per head, on -present Numbers . . £111

APPENDIX C.

CONDITION OF PAUPER PATIENTS ON ADMISSION.

COUNTY ASYLUMS.

Bedford . At the Asylum for the County of Bedford we were
informed that the general condition of the Paupers
■was much improved of late, and that they were now
brought to the Asylum soon after the attack of
Insanity.

Chester . The information obtained at the Chester County Luna-
tic Asylum was, that " The Paupers are brought in
a very bad state, in filth and in rags, and, from too
long delay, in a state when there is little or no
chance of cure."

Cornwall . At the Asylum for the County of Cornwall it was
stated by the Medical Superintendent, that in a large
proportion of cases admitted during the year 1842,
owing to long detention by friends or parishes, the
prospect of recovery had been entirely precluded ; and
that it had been the custom in the County of Corn-
wall not to send a Patient to the Asylum until he
had become, either from dirty habits, or dangerous
propensities, unmanageable in a Workhouse, or in
lodgings. The attention of the Magistrates of the
County had been called to the subject in the last
Annual Report of the Asylum.

Dorset . The Medical Superintendent of the Asylum for the
County of Dorset has for some time past directed

224-

the attention of the Magistrates of that County to
the condition in which Pauper Lunatics are sent to
the Asylum. Out of thirty-seven cases admitted
during the year 1842, only six were received within
three months after their being first attacked, eight
within twelve months, five had been insane between
two and five years, and the remaining Patients had
been afflicted from seven to thirty years. Those
admitted within three months after the first attack
of the disease had all recovered, and were discharged
within four months from the time of their admis-
sion, excepting one female, aged seventy-five, who
had been for some time in a state of senile imbeci-
lity. Amongst the evils complained of in relation to
this subject, is a habit on the part of the Clerks and
Officers of Unions, after they have received orders
from Magistrates to send Lunatics into the County ■
Asylum, of retaining them at their houses upon a
temporary mitigation or suspension of their attacks,
and of afterwards sending them to the Asylum upon
a return or an increase of their disease. In confirm-
ation of this complaint, the particulars of two Cases
were given, in which the Officers of Unions had
kept Pauper Lunatics in lodgings for several months
after Orders had been received from the Magistrates
to remove them to the County Asylum. In both cases
the Officers were subsequently obliged to send the
Paupers to the Asylum. One case occurred in April,
and the other in October, 1843. The fuU details of
these cases are in the Office of the Metropolitan
Commissioners, and the attention of the House of
Commons was called to one of them in the last Ses-
sion of Parliament by Lord Ashley.
Gloucester. All the Paupers who are now received are either sent
from the Workhouses, or are found wandering
about ; and in general they are not now detained
more than a few days in the Workhouse before they

225

are removed to the Asylum. Their condition when
first admitted is considered to be much more debi-
litated than it used formerly to be, a change which
the Superintendent ascribes to the prevailing pres-
sure of the times, and the increase of distress and
extreme poverty among the Poor.

Ki3NT . The Paupers are generally brought to the Kent Asy-
lum in a very advanced stage of their disease.

Lancaster . At the Lancaster Asylum the statement made was,
that nearly all the Patients admitted into the Asylum
were brought from Workhouses, where they had in
general been detained a considerable time, and conse-
quently the malady had become more or less con-
firmed, thus diminishing the probability of re-
covery.

Leicester . The information obtained at the Leicester Asylum was
that the condition of Pauper Lunatics generally,
when admitted, was most unfavourable. The majo-
rity of cases are of a chronic description, from deten-
tion elsewhere, and treatment totally inadequate to
their condition. The consequence was stated to be
confirmed disease, a low average of recoveries, and a
large amount of Incurables. " This state of things
" to use the words of the Superintendent, is produc-
" tive of irreparable mischief to the poor Lunatic, and
" in a pecuniary point of view entails on his Parish
" a very serious expense, which in most cases might be
" obviated by early and efficacious treatment in the
" recent stage of the malady, to say nothing of the
" gratification it would afford to every rightly cousti-
" tuted mind, to restore a wretched Maniac to health,
"to reason, and to a wife and family dependent upon
" him."

Middlesex . From the 1st of January to the end of March, 1844,
forty cases were refused admission at this Asylum,
so that there is in reality little chance of recent
cases gaining admission at Han well.
Q

226

Norfolk . The result of our inquiries at the Norfolk Asylum
was, that many Patients, Males and Females, were
admitted in very feeble health, and suffering
from the effect of pressure; but that, generally
speaking, they were not detained long in Work-
houses.

Nottingham Such has been the bad condition in which Paupers
have been brought to this Asylum, that Dr. Blake,
the late Physician, presented a petition to the House
of Lords, calling their attention to the incurable
state in which Paupers had been sent, from being
kept away long after the commencement of their
disease. The result of our latest inquiries at this
Asylum has been that, since the new Poor Law
came into operation, an increased reluctance has
been exhibited on the part of the parish authorities
to send their poor to an Asylum, and that the
Patients frequently come in a very exhausted and
debilitated state. Great advantage is said to be
taken of the use of the word " dangerous" in the
45th section of the Poor Law Amendment Act ;
and many curable cases are detained in Union
Workhouses in the rural districts.

Stafford . At the Stafford Asylum we were informed that the
Paupers were generally sent soon after the commence-
ment of the disease, but often very dirty, sometimes
in manacles, and with scarcely any clothing.

Suffolk . At the Suffolk Asylum we were told that it had
long been a source of complaint that Patients were
sent to the Asylum wretchedly fed and wretchedly
clad, and occasionally in an exhausted and almost
dying state. This, however, it was said, had not
been so much the case in recent times as formerly.
Nevertheless, the Patients are still rarely received in
an early stage of their malady. Cases have occurred
in which Patients have been brought to the Asylum
in improper conveyances, and not sufficiently pro-

227

tected from the weather, and where "death was pro-
bably accelerated by the journey and consequent
exposure."

So aREY. . At the Surrey Asylum it was stated that the Paupers
were frequently detained too long in Workhouses,
and under the care of their friends, especially in
recent cases, so as to afford little chance of cure
or benefit from medical treatment. They are sent
to the Asylum in some cases to die.

York, W. Riding. We were informed at the Asylum at Wakefield,
that the Paupers were very commonly retained so
long in the Workhouse as to leave little chance
of recovery. The reason assigned was said to be
obvious. In the Asylum 7s. a week is paid for
their maintenance; while in the Workhouse they
are maintained for less than half that sum.

LUNATIC HOSPITALS RECEIVING PAUPERS.

Lincoln. . The House Surgeon of the Lincoln Asylum stated
that a great number of Paupers were sent into the
Asylum in a state of mental and bodily health
which rendered all chance of their recovery hopeless.
He instanced three cases, in one of which the
Patient died within four days ; in another within
twenty-five days, and in the third within eight
days after admission ; and in each of these Cases
the Patient had been previously kept some time in
the Workhouse. In one instance, Mr. Smith, the
House Surgeon, refused to admit a Patient brought
to the Asylum in a dying state, without the sanction
of one of the Physicians. Dr. Charlesworth, one
of the Visiting Physicians, entirely confirmed this
statement, and called our attention to the remarks
upon this subject in the Report of the Asylum
for the year 1842.
Q 2

228

Northampton. The Medical Superintendent of the Northampton
Asylum, stated that some few of the Unions which
send their Paupers to the Asylum acted with libe-
rality and sent them at the commencement of
their malady ; but that the greater number of the
Unions either keep them in the "Workhouses or
farmed them out to other poor people at a small
sum, in some cases not exceeding 2*. 6d. a week,
until they were in a state, in which, either from
becoming destructive of their clothes or dangerous
to the persons about them, they could no longer be
kept with economy nor safety ; and that thus they
arrived at the Asylum when their bodies as well
as minds were beyond the reach of cure or remedy.

LICENSED HOUSES RECEIVING PAUPERS.

Durham . In this County the Paupers are stated to be sent to
Asylums earlier than they used to be, in 1843.

Devonshire. At Plympton St. Mary, near Plymouth, the Patients
are generally sent in a bad state. They are the
refuse of the Workhouses, many of them are Epi-
leptics, and upon an average eight out of ten are
incurable.

Gloucester. Fairford — Some of the Paupers have been sent to this
Asylum in a very bad state, and particularly during
the last year. The late Medical Attendant left an
entry in the Medical Register, stating that many
of the Paupers had entered the Establishment
who were not suffering from any acute disease,
but had the functions of life so languidly performed
that it constituted, in a great degree, their mental
malady ; the unsoundness of mind consisting more

229

in the want of power than in any perversion of tlie
reasoning faculty, or in any delusion. Thirteen
cases were instanced in which persons died in the
year 1842 very soon after their admission into the
Asylum, having been brought there in a very bad
state of bodily health. — 1843.
Hereford . Hereford Asylum. — The Pauper Patients in Mr. Gil-
liland's opinion are kept too long in "Workhouses
before being sent to the Asylum to give tliem a fair
chance of recovery.
"Whitchurch. — Paupers are frequently sent in a very
bad condition, much reduced, and under great
exhaustion.
Middlesex . AtDr.Warburton's, at Bethnal Green, not one out often
Paupers who are admitted arrive in a curable state.
Hoxton. The information received from this Asylum is,
that in the majority of instances the Pauper Patients
received have imdergone some previous treatment,
though some cases are quite recent. The greater
number of chronic cases admitted have been for some
time inmates of Workhouses.
Northumberland. Newcastle. — Paupers are received at an earlier
stage of disease than they used to be. They are
frequently brought ill- clad and very dirty.
Gateshead Fell. — Paupers are received at an earlier

stage of their disease than formerly.
Dunston Lodge. — Paupers are received in a better state
and earlier than they used to be. A female, how-
ever, had, immediately previous to one of our visits,
been received who had been Insane twenty years,
and was sent because she was noisy and trouble-
some.
Oxford . Hook Norton. — The majority of the Paupers sent inta
the Asylum are old cases which have previously been
kept for some time in the Workhouse, a circumstance
which is considered to operate unfavourably to their
recovery.

230

Shropshire. Kingsland, near Shrewsbury. — The Paupers are not
sent to the Asylum in so bad a condition as formerly.
They are even now kept too long, so that the chance
of cure is in many cases small.
Somersetshire. Fairwater House, near Taunton. — The prospect of
recovery as regards the Tauper Patients is but
slender, their cases being generally of long standing
before their admission.
Bailbrook House, near Bath. — The condition of the
Paupers who come from the Bath district is such as
in general to afford little prospect of recovery. From
other districts the prospect of recovery is now more
favourable, because they are usually sent on the first
outbreak of the disease.
Hampshire . Hilsea Asylum, near Portsmouth. — The Paupers are
frequently sent in an advanced stage of their disease,
and in a bad state. They are usually sent, in the
first instance, to the Parish Workhouse, and are
kept there as long as they can be managed, and
when they become violent or dirty, they are removed
to the Asylum.
Nursling, near Southampton. — The Insane Poor are
not unfrequently detained improperly in "Work-
houses, and many of them come in a state of great
debility and exhaustion from having refused food.
Suffolk; . Belle Vue House, near Ipswich. — Pauper Patients are
generally detained as out-door Paupers by their
friends until they become unmanageable. The blame
is considered not to rest so much with the Relieving
Officers of Unions, as with the friends under whose
care the Pauper Lunatics are placed by the Parish
Authorities.
Waravick . Duddeston, near Birmingham. More than half the
Patients under the care of Mr. Lewis belong to the
parish of Birmingham, where the practice is to detain
them in the lunatic wards of the Workhouse until
they become unmanageable, when they are sent to

231

Duddeston. It is stated, not only that the worst
cases are sent to that Asylum, but that those who are
in a state of improvement are prematurely removed
back to the Workhouse.

WiLTsHiKE . Fisherton House, near Salisbury. — The Paupers are
frequently kept, either at their own houses or in
Union "Workhouses, so long after the attacks of their
disease that their chances of recovery are much
diminished.
Laverstock House, near Salisbury. — Since the
establishment of Unions, Paupers are sent in an
earlier stage of their disease than they used
to be.
Belle Yue, Devizes. — Some of the Paupers are brought
in a very bad state, being detained as long as they
are manageable, or can be kept cleanly. Many from
Wales are violent, and bad cases when they arrive.

Worcester . Droitwich. — Paupers are very frequently sent in an
extremely bad condition, having been previously
detained for a considerable time in Workhouses,
and then brought to the Asylum in carts, bound
with cords.

Yorkshire . Gate Helmsley. — At our first visit the information was,
that Paupers were frequently brought in an advanced
stage of their disease, so as to afford little prospect
of recovery. They are said to be now brought in a
better state.
Dunnington. — The Paupers are often sent in a very
filthy state^ bound with cords, and otherwise re-
strained. In some cases the Patient has been kept a
long time after the commencement of the disease
before he is brought to the Asylum. In others
he is brought soon after the commencement of his
illness.

Hull . , . Refuge, Hull. — It is stated that the Paupers are
admitted in the last stage of disease, and that little
medical history of the cases can be obtained from

232

Parislies. As an instance of the condition in which
they are sometimes brought to the Asylum, the case
of a female pauper was mentioned, who was received
in November last, from Blighton, near Gainsborough.
She was in the last stage of phrenitis, was conveyed
to the Asylum wrapped up in a blanket, which was
thrown over her head ; and she was, when received,
in a profuse perspiration. She died within eight
days of admission. The Parish Officers of Hull
are said to have been more cautious in this respect of
late years than formerly, partly, as it is believed,
in consequence of a male Pauper Lunatic detained
in the Workhouse having, in a paroxysm of mania,
stabbed three or four of his fellow paupers, one of
whom died of his wounds.

WORKHOUSES.

Redruth . In the Union Workhouse at Redruth, visited on the 6th
October, 1843, there were 41 Insane Persons, besides
5 others of weak intellect, and unable to take care of
themselves, but who had not been returned as insane
in the return of Lunatics made to the Clerk of the
Peace in the year 1842. Out of these 41 Insane
Persons there were 6 Idiots. Several of the women
were stated to be occasionally violent; one of them
sometimes requiring handcuffs, a second having
attempted to escape, and a third to break windows.
Several had delusions: one female, who had at-
tempted to destroy herself, fancied her body not to be
her own. Amongst the men, some were at times
violent; others who had been very violent were
become enfeebled. It was stated that if any of the
men required restraint it would be employed . One
woman was extremely dirty, and addicted to dis-
gusting habits.

233

Bath . . lu the Union AVorkhouse at Bath, visited on the 20th
of October, 1843, there were 21 Insane Persons;
12 Males, and 9 Females. Of these, 3 were subject
to fits, and 3 were Idiots — one woman was in bed
and had on a strait waistcoat, and was constantly
under such restraint. Another woman was excited
and in bed ; the rest of the Lunatics appeared
in tolerable health. One man had been in the
House since the 22nd of June previous, and from
his own statement, confirmed by the Master of the
House, it appeared that he had had no medicine or
medical treatment since his admission, although his
case appeared to be one that was susceptible of
improvement by proper remedies.

Leicester . In the Union "Workhouse at Leicester, visited on the
6th October, 1843, there were 30 Insane Persons,
namely 11 Males and 19 Females. Of the males,
"W. K. was a noisy Maniac, very cunning, and occa-
sionally striking the other men in the ward. P. R.
was subject to maniacal attacks, during which he
was placed in a strait waistcoat. He was raving mad
about two months before our Visit, and was constantly
fastened to his bed at night to prevent him from injur-
ing or annoying the other inmates. A. H. was violent
and passionate, and tried to cut others with knives ;
and all these persons were dangerous. Amongst the
other cases, were, J. L., an Epileptic ; J. D. a case
of Melanckolia ; J. G., formerly in the Asylum,
and still Insane, noisy, and abusive. The rest of the
Males of this class appeared to be either harmless
Idiots, or in a state of mental imbecility. The three
most dangerous of the females were, C B., admitted
June 12th, 1839, a destructive and dangerous Idiot;
M. H., admitted 23rd of February, 1839, an abusive
and dangerous Lunatic. She was brought to the
AYorkhouse in a state of violent excitement, by two
policemen. M". A. R., admitted 24th of February,

234

1841, a quarrelsome and dangerous Idiot, once
knocked out the teeth of a child. To these may be
added the following, as properly coming within the
description of dangerous Lunatics : — M. B., a sullen
ill-tempered person, who refused to be employed, and
< had threatened, when at home, to kill her mother.
A. W., in the "Workhouse three years, an abusive
Lunatic, who had occasionally struck most of the
women in the ward, particularly a paralytic patient
who could not defend herself. J. S., an irritable mad
woman, who threw knives at those with whom she
happened to have a dispute. E. H., a violent, iras-
cible person, subject to maniacal excitement, and
dangerous when irritated. She had been twenty-six
weeks in the County Asylum, having become unman-
ageable at home after the death of her mother, sixteen
years ago, — and was said to strike the inmates mali-
ciously. A. H., a harmless Lunatic, with delusions,
was most improperly sent to the Workhouse, instead
of the Asylum, four years ago. Besides the above,
tliere were in the House 6 quiet female Lunatics, all
confirmed cases, and 5 Idiots. There were in the
House altogether, 3 Males and 9 Females, properly
to be classed as dangerous Lunatics.

PoRTSEA . In the "Workhouse at Portsea, near Portsmouth,
visited on the 28th of August, 1843, there were 26
Lunatics ; 15 Females, and 11 Males. Of these, 7
were Epileptics, and 2»Idiots. Many of the Patients,
although not strictly speaking, imbecile persons,
were individuals of weak intellect. Some of them,
however, were decidedly Insane, and occasionally
violent and unmanageable unless restrained, and some
of them were labouring under delusions.

Birmingham. In the Workhouse at Birmingham, visited on the
29th of September, 1843, there were 71 Lunatics.
Amongst them was an unusual proportion of Epi-
leptics, namely, 11 Males and 16 Females. Several

235

of these were Idiots : others were subject, after their
paroxysms of Epilepsy, to fits of raving madness, or
Epileptic furor, during which they were stated to he
excessively violent. Besides these, there were several
patients who were occasionally under great excitement,
and furiously maniacal. Two of the females had strong
suicidal propensities, and one of them had attempted
suicide. There is no class of persons more dangerous
than are those Epileptics who are subject to attacks
of Epileptic furor or delirium. It is well known
that many fearful homicides have been perpetrated
by persons afflicted with this form of mental disease.

APPENDIX D.

List of Counties having County Lunatic Asylums exclusively
for Paupers, with the numbers of Pauper Lunatics in each
county, and the numbers for whom there is accommoda-
tion in each Asyliim.

Pauper Lunatics.

Numbers

in
County,

1842.

Accommodation.

Numbers
for whom
there is.

Numbers

for whom

there is

not.

Bedford.

Lunatics in County

Accommodation in County Asylum
Chester.

Lunatics in Unions

Not in Unions . . . . ,

Accommodation in County Asylum for
Dorset.

Lunatics in County . . . .

Accommodation in County Asylum for
Kent.

Lunatics in Unions . . . ,

Not in Unions ... . .

135
180

2731
23/
110

227
113

465
13

478
Accommodation in County Asylum for 300
Lancaster.

Lunatics in Unions . . . .979
Not in Unions 123

1102
Accommodation in County Asylum for 600
Middlesex.

Lunatics in Unions . . . 884

Not in Unions . , ... 735

I 1619

Accommodation in County Asylum for 1000

Norfolk.

Lunatics in Unions . . . .401
Not in Unions 69

470
Accommodation in County Asylum for 220

Suffolk.

Lunatics in County . . . .361

Accommodation in County Asylum for

Surrey.

Lunatics in Unions . . , .521
Not in Unions 70

591
Accommodation in County Asylum for 350
York, West Riding.

Lunatics in Unions .... 664
Not in Unions 363

1027
Accommodation in County Asylum for 420

155

296

227

478

1102

1619

470
361

591

1027

141
155

113
300
593

1000

220
180

360
420

141

114

178

509

619

250

181

231

607

* According to the Poor Law Returns for 1842; since which the numbers of
Pauper Lunatics, (as will bo seen by reference to Appcndi.x F), and consequently
the deficiency of accommodation in Asylums have increased.

237

List of Counties having County Lunatic Asylums for Paupers
in union with Subscription Asylums, with the numbers of
Pauper Lunatics in each County, and the nmnbers for
whom there is accommodation in each Asylum. The
numbers of Pauper Lunatics belonging to Parishes not
in Unions have been calculated at one in a thousand of
the population, according to the Census of 1841.

Pauper Lunatics.

Numbers

County.

1842.

Accommodation.

Numbers
for whom
there is.

Numbers

for whom

there is

not.

Cornwall.

Lunatics in Unions .... 273
Not in Unions ... .24

Total Lunatics . . 297
Accommodation in County and Sub- 1 , „„
scription Asylum for Bodmin . J

Gloucester.

Lunatics in Unions .... 398
Not in Unions . . . .100

Total Lunatics . . 498
Accommodation in County and Sub- 1 ,^^
scription Asylum for . . . J

Leicester.

Lunatics 244

Accommodation in County and Sub-"] ,^^
scription Asylum for . . .J

Nottingham.

Lunatics in County and County ofl „^,
Town 1 ^bl

Paupers in County and Subscription T

Asylum for County and Town in V 125
1842 J

Stafford.

Lunatics in Unions , . . . 384
Not in Unions ... .68

Total Lunatics . .452

Paupers in County and Subscription "1 , --

Asylum in 1842 . . •/ ''

297

498
244

261

452

129

190
104

125
185

168

308
140

136

267

?38

List of Counties in England, with the numbers of Pauper
Lunatics, and the total accommodation for them in Public
and Private Asylums in each County. The numbers of
Pauper Lunatics as to that part of the population which
is not comprised in Unions have been calculated at one
in a thousand of the population, according to the Census of
1841.

Pauper Lunatics and total Accommodation,

Numbers
in

Accommodation.

Numbers

in Public and Private Asylums.

County,

for whom

there is

not.

1842.

there is.

Bbdford.

Lunatics in County . . . .135

Accommodation in County Asylum for 180

135

180

Berkshire.

Lunatics in County .... 241

241

. .

241

Buckinghamshire.

Lunatics in County . . . .127

127

. .

127

Cambridge.

Lunatics in County .... 159

159

. .

159

Chester.

Lunatics in Unions .... 273

Not in Unions .... 23

296

Accommodation in County Asylum for 110

296

155

141

Cornwall.

Lunatics in Unions .... 273

Not in Unions 24

297

129

168

297

Accommodation in County and Sub- "1
scription Asylum at Bodmin .J

Cumberland.

Lunatics in County . . . .161

161

. .

161

Derby.

Lunatics in Unions . . . .164

Not in Unions . .... 52

216

Accommodation in Licensed House, 7

Hill Lane, Derby, for . .} ^*

216

192

* Devon.

Lunatics in Unions .... 508

Not in Unions 103

611

Accommodation in House at P]}inp- "1
ton, licensed for . . .J

Workhouse at Stoke Damerel licensed "1 „,,
for 100, but only room for . / *^"

100

611

100

511

A County Asylum for Dcvonsliire has been erected, hut is not yet opened.

239

Pauper Lunatics and Accommodation,
Public and Private.

Numbers

in
County.

Accommodation.

Numbers
for wliom

there is.

Numbers

for whom

there is

not.

Dorset.

Lunatics in County ....
Accommodation in County Asylum for

227
113

227

113

114

Durham.

Lunatics in County ....
Accommodation in Private Asylums at

Wreckenton, licensed for

West Aucliland, do. for

Gateshead Fell, do. for

Benshams, do. for .

Dunston Lodge, do. for

210

40
82
52

Essex.

Lunatics in County ....

Accommodation in Licensed House"!

at Witham for . . . .J

297

325

210
325

297
2

323

Gloucester.

Lunatics in Unions ....
Not in Unions . . ...

398
100

Accommodation in County and Sub- "1
scription Asylum for . . .J
Private Asylum at Fairford, licensed for
,, „ Stapleton, do. for .

498

190

120
5

314

498

315

103

Hereford.

Lunatics in County ....
Accommodation in Private Asylums at

Hereford, licensed for

Whitchurch, do. for .

147

28
20

147

Hertford.

Lunatics in County .

214

Huntingdon.

^ Lunatics in County ....

Kent.

Lunatics in Unions ....
Not in Unions . . ...

465
13

Accommodation in County Asylum for
Private Asylum at West Mailing for .

478

300

312

478

312

166

Lancaster.

Lunatics in Unions ....
Not in Unions . ....

979
123

Accommodation in County Asylum for
In Liverpool Asylum in 1842

1102

593

G-29

1102

629

473 1

240

Pauper Lunatics and Accommodation,

Numbers

Accommodation.

Numbers
for whom
there is.

Numbers!

Public and Private.

in
Comity.

for whom'

there is

not.

Leicester.

Lunatics in County . . . . 244

Accommodation in County and Sub- "1 , „ „
scription Asylum for . • • J

244

130

114

Lincoln.

Lunatics in County .... 296

Paupers in Lincoln Subscription Asy- 1 -o
lum, in 1842 . . . . J '"^

296

223

Middlesex.

Lunatics in Unions . . . . 884

Not ia Unions ..... 735

1619

Accommodation in County Asylum for 1000

Private Asylums at Bethnal Green, 1 „-_
licensed for ... J

At Hoxton, licensed for . . . 300

1619

1560

Monmouth.

Lunatics in County .... 105

105

. ,

105

Norfolk.

Lunatics in Unions .... 401

Not in Unions 69

470

Accommodation in County Asylum for 220

Paupers in Bethel Hospital, in 1843 . 72

In Bethel Infirmary or Poorhouse . 27

319

470

319

151

Northampton.

Lunatics in County . . . . 269

Accommodation in Subscription Asy- "1 , oi
lum at Northampton, in 1842 .J

269

181

Northumberland.

Lunatics in County . . . .32]

Accommodation in Private Asylum at "1 , „
Newcastle, licensed for . • J

321

263

Nottingham.

Lunatics in County and County ofl „„,
Town 1 ^01

Paupers in County and Subscription 1 , , „
AsylumforCounty&Towninl842.J '

261

125

136

Oxford.

Lunatics in Unions . . . .172

Not in Unions 20

192

Private Asylum at Hook Norton, "I ^,
licensed for . , . • J '

192

118

Rutland.

Lunatics in County . . . .24

Salop.

Lunatics in Unions . . . . 244

Not iTi Unions 47

291

241

Pauper Lunatics and Accommodation,
Public and Private.

Salop — continued.

Brought forward . , . . 291
Accommodation in Private Asylum, "1

at Kingsland, near Shrewsbury, 5- 80
licensed for . . . .J

At Morda, near Oswestry, in 1842 . 14

An Asylum is in progress of erection
in this County.

Somerset.

Lunatics in County .... 572
Accommodation in Private Asylums,! ^p.

at Bailbrook, near Bath, for . J

At Fairwater House, near Taunton,"! „

licensed for . . . . J

Southampton.

Lunatics in Unions .... 405
Not in Unions . . . . .43

448
Accommodation in Private Asylums, at!
Lainston, near Winchester, licensed J- 80

for ....

Nurstling, near Southampton,'
Hilsea, Portsmouth, licensed i
In Carisbrook, in 1843

licensed for
for .

Stafford.

Lunatics in Unions
Not in Unions .

38
27

207

384
68

452
185

Paupers in County and Subscription "1
Asylum in 1842 . . . .J

Private Asylum, Sandfield, near Licli- 1 nn
field, licensed for .

Suffolk.

Lunatics in County ....
Accommodation in County Asylum for
Private Asylum, Belle Vue, near
Ipswich, licensed for

Surrey.

Lunatics in Unions ....
Not in Unions .....

215

361

180

521

591

Accommodation in County Asylum for 360
Private Asylum at Peckham, licensed for 210

Sussex.

Lunatics in County

Numbers

in
County.

291

572

448

452

361

591

251 251

Accommodation.

Numbers
for whom
there is

207

215

196

570

Number!

for whom

there la

not.

197

479

241

237

165

21
251

242

Pauper Lunatics and Accommodation,
Public and Private.

Numbers

in
County.

Accommodation.

Numbers
for whom
tbere is.

Numbers

for whom

there is

not.

Warwick.

Lunatics in Unions .... 225
Not in Unions , . , . . 181

406

Accommodation in Private Asylum at! -^
Duddeston, licensed for . . .J

406

346

Westmoreland.

Lunatics in County .... 50

Wilts.

Lunatics in Unions .... 357
Not in Unions ..... 25

382
Accommodation in Private Asylum at"! „c

Laverstock,near Salisbury, licensed for J
Fisherton, near Salisbury, for . . 90
Devizes, licensed for . . . .180
Market Lavington, licensed for . .135
HindoD, licensed for . . . . 2

442
Worcester.

Lunatics in County .... 284
Accommodation in Private Asylum at "1 -^
Droitwich, licensed for . . J
York, East Riding.

Lunatics in Unions . . . .173
Not in Unions 14

382

284

442
60

224

187
Accommodation in Private Asylums at

Nunkeeling, licensed for . . 2C
Heple, near Hull, do. for . . 24
Hull Retreat, do. for . . . 96
Somercoats, near Hull, do. for , i
Hunington, near York, do. for . 30

173
York, North Riding,

Lunatics in Unions . . . .144
Not in Unions ..... 2i:

187

173

167

Accommodation in Private Asylum at

Gate Helmsley, licensed for . 40

167

127

York, West Riding.

Lunatics in Unions .... 664
Not in Unions 363

1027
Accommodation in County Asylum for 420
,, at Private Asylum"! ,-
at Acomb, in 1842 . . . /

435

1027

435

592

AiNSTV, AND City of York, and Suburbs.

Lunatics . . . . . 3S
Private Asylum at Heworth, licensed for 13

243

WALES.

Panper Lunatics and Accommodation,
Public and Private.

Numbers

in
County.

Accommodation.

Numbers
for whom
there is.

Numbers

for whom

there is

not.

Glsmorgan.

Lunatics in 155

Private Asylum at Briton Tarey, \ „/.
licensed for J

Pembroke.

Lunatics in .... . 105
County Asylum at Haverfordveest . 18

155
105

36
18

119

Counties in England and Wales in which there are no
Asylums of any kind, either Public or Private, and
the number of Pauper Lunatics chargeable to
Unions in each County, August, 1843 : —

ENGLAND.

Berkshire

Buckinghamshire

Cambridge

Cumberland

Essex .

Hertford .

Huntingdon .

Monmouth • .

Rutland

Sussex

Westmoreland

Anglesey

Brecon

Cardigan

Carmarthen .

Carnarvon

Denbigh

Flint

Merioneth

Montgomery .

Radnor

WALES.

PAUPER LUNATICS.

. 260

. 147

143

, 173

354

225

. 117

. 278

•

. . 65

119

162

149

, ,

107

APPENDIX E.

DIETARIES OF PAUPER PATIENTS.

Note,— The Weekly Charges for Pauper Patients will be found in the Lists of Asylums,

Appendix A.

COUNTY ASYLUMS.
BEDFORDSHIRE.

Males.
Milk Porridge, with 8 oz. of Bread.

bbeakfast.

Females.
Milk Porridge, with 7 oz. of Bread.

Tea and Bread and Butter for a portion of the Patients, instead of
Milk Porridge.

DINNERS.

Sunday, Tuesday, and Thursday.
6 oz. Meat, with Vegetahles.

Monday, Wednesday, and Friday.

8 oz. Bread, with Soup, made from

Meat hoUed the preceding day.

Saturday.
1 Ih. Suet Pudding.

Sunday, Tuesday, and Thursday.
5 oz. Meat, with Vegetables.

Monday, Wednesday, and Friday.
7 oz. Bread, with Soup.

Saturday.
f lb. Suet Pudding.

SUPPEB.

Bread, 8 oz.; cheese, 2 oz.; and
half-a-pint of Beer.

Bread, 7 oz.; cheese, 1^ oz.; and
half-a-pint of Beer.

Tea and Bread and Butter for a portion of the Patients, the same as

Breakfast, each day, instead of Bread, Cheese, and Beer.
Patients employed in the House and Garden have half-a-pint of Beer

twice each day.
Sunday afternoon, all the Female Patients have Tea and Currant Cake.
Patients, who require it, have anything that is ordered by the Medical

Superintendent.

245

CHESHIRE.

Breakfast.

Dinner.

Supper.

Monday . .

Porridge, with Milk,

Strong Meat Soup, with

As Breakfast.

1 quart ; for Men,

Vegetables and Sea-

2 oz. Bread in Por-

soning, 1 quart ;,

ridge.

Bread, 6 oz.

Tuesday . .

Ditto.

6 02. Beef or Mutton,
or other Meat.

Ditto.

Friday . , .

Ditto.

6 oz. Bread,

Ditto.

Saturday . .

Ditto.

1 lb. Potatoes.

Ditto.

Wednesday •

Ditto.

Pudding, with Treacle
for Sauce (much ap-
proved.)

Ditto.

Thursday

Ditto.

1 quart of Soup, as
above ; 6 oz. Bread ;
1 lb. Potatoes.

Ditto.

Sunday . .

Cocoa or Coffee, with

1 quart Meat Sconce

Ditto.

Sugar, Milkj Bread

or Irish Stew, sea-

and Butter.

soned with Onions
and Pepper ; 3 or 4
oz. Bread ; Bacon
sometimes added,
well chopped, to the
Stew.

;

One horn of Beer allowed each Mau with his Dinner, daily.

CORNWALL.

Males.
Breakfast . Sunday, \
Monday,

Tuesday, ) Broth, 1 pint; Bread, 7 oz.
Wednesday,
Friday, J

Thursday, J Milk, ^ pint; Wa,ter, ^ pint;
Saturday, \ Oatmeal, 3 oz.; Bread, 6 oz.

Dinner . . Sunday, ^

Monday, f Peas Soup, 1^ pint; Bacon, 2 oz.; Bread,

Thursday, t 4 oz.

Friday, ;

Tuesday / Stew, 2 lbs.; Meat, 2 oz.; Suet Dump-

'^' ( ling, 4 oz.

S t -d I ^^"P' ^i P"^*' Vegetables; Bread, 6 oz.

Supper , . . • . Oatmeal Porridge, 1^ pint; Bread, 4 oz.

Breakfast
Dinner .

Sunday,

Thursday,

Monday,

Tuesday,

Thursday,

246

Females.

Oatmeal Gruel, 1^ pint, containing Milk,
I pint; Oatmeal, 1| oz. ; Cake, 5 oz.

Supper

J- Same as Males,

Same as Males, with 3 oz. of Bread,
i Same as Males.

Sdf ^'^' } ^^"'^ ^' ^^^^'' ^'^^^' ^ ''"•

Tea, with 5 oz. of Bread and Butter.

Dinner

DORSET.
Sunday, "\

Monday, (Meat, 5 oz. cooked, free from bone, and
Wednesday, t Vegetables.
Thursday, )

Tuesday, . 1 pint of Soup ; Bread, 6 oz.
Friday, . . Suet Puddmg, 1 lb.

Q , i j Pie Crust, |^lb.; Potatoes; Meat, 3 oz.;

oaturdav, s x> i • ^ i 'i
•" ( Beer, i pmt daily.

breakfast.

Males.

1 pint Milk Porridge, thickened
with Oatmeal ; Bread, 6 oz.

Females.

1 pint Milk Porridge, thickened
with Oatmeal; Bread, 5 oz.

SUPPER.

Bread, 6 oz. ; Cheese, 2 oz. ;
Beer, J pint.

Bread, 5 oz. ; Cheese, 2 oz. ;
Beer, J pint.

The Female Patients, who make themselves generally useful, have Tea

and Butter, if preferred.
The out-door Workers and Laundry Women have an extra quantity of

Beer daUy.

GLOUCESTER.

Breakfast. . 1 lb. of Bread with Butter, and three parts of a Quart
of Milk Gruel.

1 part Milk.

2 " Water.

1 " Flour and Oatmeal.

247

Supper. . . ^Ib. Bread with about 1 oz. Cheese, and a Pint of Table
Beer for the Men.
Tea and Bread and Butter for Women (no limit).
Dinner. . . 6 oz. of dressed meat (Beef or Mutton) on Tuesdays,
Thursdays, and Sundays, with Potatoes and Bread,
and one Pint of Table Beer. (Healthy Male
Patients 8 oz.)

Saturday. — Meat Pies and Irish Stew.
Monday. — Broth with Bread, and Vegetables,
6 oz. Bread, Potatoes in addition. No Beer.

Friday. — Rice Pudding and a slice of Bread,
No Beer.

KENT.

Breakfast.

Dinner.

Supper.

Sunday . .

Porridge of Oatmeal
and Milk, with 6
ounces of Bread,
every morning, for
all the Patients.

For Men 6 oz. of Boiled
or Roast Beef, free
from bone; 4 oz. of
Bread, and ^ Pint of
Table Beer. —The
Women have 4 oz.
of Meat, &c. &c.

For Men 2 oz. Cheese,
and § Pint Beer
every evening ; for
Women Tea, with
Bread and Butter in
the proportion of
1 oz. Tea and 3^ oz.
Butter a week.

Monday . .

Ditto.

Beef Pudding, Vege-
tables, and Beer, as
before.

Ditto.

Tuesday . .

Ditto.

Soup made from the
bones of the preced-
ing days, -with thin
Beef added, thick-
ened with Scotch
Barley, Oatmeal, and
Vegetables, and 6 oz.
of Bread.

Ditto.

Wednesday .

Ditto.

Meat Pies or Pudding,
as before.

Ditto.

Thursday . .

Ditto.

Rice or Suet Pud-
ding; Men, 12 oz..
Women, 10 oz. ;
Bread, 4 oz.

Ditto.

Friday . . .

Ditto.

Meat in quantities the
same as on Sunday.

Ditto.

Saturday . .

Ditto.

Soup as on Monday, or
Suet Pudding as be-
fore.

Ditto.

A Pint of Beer and 2 oz. of Meat on Pudding Days.

248

LANCASTER.

MEN.

Breakfast.

Dinner.

Supper.

Bread.

Oatmeal

and
Flour.

Mutton
or Beef
uncook-
ed, with
Bones.

Bread.

Flour.

Bread.

Oatmeal

and
Flour.

Cheese.

Sunday
Monday
Tuesday
Wednesday.
Thursday .
Friday . .
Saturday .

Total

5 oz.
5 —
5 —

5 —
5 —
5 —

3i 07..

H —

r —

3^ -
3J -

H -

7 oz.

7 —

3| -

7 —
7 —
7 —
7 —

4 oz.
4 —

7ioz.
5 —

7i -

n -

5 —
7i -
7i -

Coffee.

Porridge.

Beer.

Tea.

Porridge.

Beer.

Tea.

3^ oz.

2 oz.
2 —

2 oz.

31 -

45|

46i

WOMEN.

Breakfast.

Dinner.

Supper.

Bread.

Oatmeal

and

Flour.

Mutton
or Beef
uncook-
ed, with
Bones.

Bread.

Flour.

Bread.

Sunday ....
Monday ....
Tuesday ....
Wednesday . . .
Thursday . . .
Friday ....
Saturday . . .

5^ oz.

H -
H -
H -
H -
H -

2f oz.
2f -
2f _
2f -
2f _
2f -
4 —

7 oz.

7 —
7 —
7 —
H -

7 —
7 —

5^ oz.

5i -
5i -
5i -
Si -
H -

5i -

with Tea.
« Coffee.
" Ditto.
" Tea.
« Coffee.
" Ditto.
" Ditto.

1 oz.

3^ oz.
4 —

tal

20A

38i

LEICESTERSHIRE.

Breakfast . Sunday, Porridge of Oatmeal and Milk, with 4 oz,

of Bread; the Males being allowed 1^
pint ; the Females 1 pint.

Dinner . . . . Roast or BoUed Meat, 8 oz. for the Men,

and 6 oz. for the Women, when cooked
and free from bone ; Potatoes and other
Vegetables ; I pint of Table Beer for
the Men, | pint for the Women.

249

Tea .... Allowed the Females only. 6 oz. of Bread,

and 1 oz. of Butter per day, with 1 oz.
of Tea, and ^ pound Sugar per week.

Supper . . . . Bread and Cheese and Table Beer; the

Men being allowed 6 oz. of Bread, 1 oz.
of Cheese, with 1 pint of Table Beer ;
the Women 4 oz. of Bread, ^ oz. of
Cheese, with ^ pint of Table Beer.
Monday, Soup, made from the Liquor in which the
Meat had been boiled the day previous,
thickened with Peas and other Vegeta-
bles ; 1^ pint for the Men, 1 pint the
Women ; Bread and Cheese, 6 oz. of
the former, and 1 oz. of the latter, for
the Men; the Women being allowed
4 oz. of Bread, | oz. of Cheese. Tea
and Supper as before.
Wednesday, Soup, as on Monday, with the same allow-
ance of Bread and Cheese and Table
Beer. Tea and Supper as before.
Tuesday, Boiled Mutton, Men, 8 oz.. Women, 6 oz.,
with Vegetables; Men 1 pint. Women
I pint of Table Beer. Tea and Supper
as before.

Thursday, Boiled Beef, in the same quantity as the
Mutton on Tuesday, with Vegetables and
Table Beer. Tea and Supper as before.

Friday, Soup, as on Wednesday, with the same
allowance of Bread and Cheese and Beer.
Tea and Supper as usual.

Satm-day, Meat Pies, or Suet or Rice Puddings, 1 lb.
to the Men, | lb. to the Women, with
Bread and Cheese and Table Beer.
This Dietary is occasionally varied by the addition of Fruit Puddings in

the season.

Breakfast
Dinner .

Supper

250

MIDDLESEX. (Hanwell.)

Males,

Sunday,

Tuesday,

Wednesday,

Friday,

Monday,

Thursday,
Saturday,

Milk, thickened with Oatmeal and Flour,
1 pint ; Bread, 6 oz.

^ Meat, 5 oz. cooked.
(Yeast Dumpling, 4 oz,
fBeer, ^ pint,
) Vegetables,

1 pint Soup; Bread, 6 oz.; Beer, ^ pint.
j Irish Stew, 12 oz. ; Bread, 6 oz. ;
( Beer, half-a-pint.

f Meat Pie Crust, 12 oz. ; Meat, li oz. ;
\ Beer, haLf-a-pint.

Bread, 6 oz. ; Cheese, 2 oz, ; Beer,
half-a-pint.

EXTRAS TO WORKMEN.

Out-door Workers to he allowed ^ pint of Beer at 11 o'clock, a.m. and

at 4 P.M. daily, and 1 oz. of Tea and 4 ozs. of Sugar per week.

Breakfast
Dinner .

Supper

Females.

. Bread, 5 oz. ; Butter, ^ oz.; Sugar, 4 oz.
per week; Tea, 1 pint.

Stmday, "^ Meat, 5 oz. cooked.

Tuesday, (Yeast Dumpling, 4 oz.

Wednesday, j Beer, half-a-pint.

Friday, / Vegetables.

^ , ( 1 pint Soup; Bread, 6 oz.; Beer, half-

Ti,,,va^a^ / I^i^^ ^*®^' 12 oz.; Bread, 5 oz,; Beer,
inm-saay, | half-a-pint,

„ , / Meat Pie Crust, 12 oz. ; Meat, lA oz. ;

baturaay, | ^^^^.^ half-a-pmt.

. Milk, thickened with Oatmeal and Flour,
1 prut ; Bread, 5 oz.

EXTRAS TO LAUNDRY WOMEN, &c.

Laundry Women to be allowed half-a-pint of Beer at 4 p. M., and toge-
ther with Helpers, &;c., 1 oz. of Tea and 4 oz. of Sugar per week,
in heu of the ordinary Supper.

251

Breakfast (daily)

. Sunday,

Dinner

Monday,
Tuesday,

NORFOLK.

Men.

Supper (daily)

Bread, 6 oz. ; Milk Broth, 1| pint, or

1 oz. of Cheese and 1 pint of Beer.

Beef or Mutton, 4 oz. cooked ; Bread,

2 oz.; Potatoes, 1 lb.; and Beer, 1 pint.

J Suet Pudding, 10 oz.; Potatoes, 10 oz.;

\ Beer, 1 pint.

j'Beef or Mutton, 4 oz. ; Bread, 2 oz. ;

\ Potatoes, 1 lb.; Beer, 1 pint.

Axr A /I /Suet Pudding, 10 oz.; Potatoes, 10 oz.;
weanesaay, I Beer, 1 pint.

rp, 1 TBeef or Mutton, 4 oz.; Bread, 2 oz. ;

^' \ Potatoes, 1 lb.; Beer, 1 pint.

Tji . 1 / Suet Pudding, 10 oz.; Potatoes, 10 oz.;

^' \ Beer, 1 pint.

Saturdays, . Ditto ditto ditto.

Bread 6 oz. ; Meat Broth, !
Cheese, 1 oz. ; Beer, 1 pint

pint, or

Breakfast

(daily)

Dinner

Sunday,

Monday,

Tuesday,

Art/ AflTK^GnOI

VV cU.llt/&U.cl'

Thursday,

Supper .

Friday,
Saturday,
, Sunday,

Women.

Milk Broth, 1^ pint, or Tea, half-a-pint, or
Beer, half-a-pint; Bread, 5 oz., in lieu
of Broth (if preferred) ; 1 oz. Cheese
or ^ oz. Butter.

Beef or Mutton, 4 oz. cooked ; Bread,
2 oz.; Potatoes, 1 lb.; Beer, half-a-pint.

(Suet Pudding, 10 oz.; Potatoes, 10 oz.;
Butter, ^ oz,
(Beef or Mutton, 4 oz.; Bread, 2 oz.;
Potatoes, 1 lb.; Beer, half-a-pint.
Wednesday, / Suet Pudding, 10 oz.; Potatoes, 10 oz.;

{Beef or Mutton, 4 oz.; Bread, 2 oz.;
Potatoes, 1 lb. ; Beer, half-a-pint.
{Suet Pudding, 10 oz.; Potatoes, 10 oz.;
Butter, ^ oz.
Ditto ditto ditto

Meat Broth, IJ pint; and Bread, 5 oz.;
or Cheese, 1 oz.; and Beer, half-a-pint,
or Tea, half-a-pint ; and Butter, 1 oz.

(Bread, 5 oz.; Cheese, 1 oz.; or Butter,
I oz.; and Beer, half-a-pint.

Monday,

252

Tuesday,

Wednesday,

Thursday,

Friday,

Saturday,

The same as on Sunday.
The same as on Monday.
The same as on Sunday.
The same as on Monday.
Ditto ditto.

NOTTINGHAM.

MALES.

Meat.

•13

■3

Ib.oz.

Pint.

O
Ib.oz.

Pint.

(1(

lb. oz.

Ib.oz.

Dms.

Ib.oz.

lb. oz.

Ib.oz.

Ib.oz

Sunday ....

13|0 10

4 jO 1

. ,

Monday ....

. .

1 10 10

Tuesday ....

. .

« 1

Wednesday

. .

Thursday

, .

. .

« i

Friday ....

. .

, .

Oil

Saturday

10
6 8

1 5

i
If

lbs. .

2 2

1 6

7 3

FEMALES.

Meat.

1
1

1
o

a
o

Ib.oz.

lb.(

■)7,.

lb. oz.

Ib.oz.

Pint

Ib.oz.

Pint.

Ib.oz.'

Ib.oz.

Dms.

Ib.oz.

Ib.oz.;

Ib.oz.

Sunday

. .

. ,

^0 A

Monday

. .

20 1

io 1

Tuesday

, ,

•• }

10 ^

Wednesday

. .

. ,

20 ^

Thursday .

, .

.. 1

Friday . .

. ,

« 1

20 i

Saturday .

.. 1

1
3

—

lbs. .

1 15

1 3

6 12

5 i

60 If

. .

or^

STAFFORD.

Males.

Breakfast . . . Milk Porridge, 1 pint ; Bread, 8 oz.

Dinner . Sunday, Meat, 8 oz. cooked; Bread, 6 oz. ; Beer,

1 pint ; Vegetables.
Meat Pie, 1 lb. ; Vegetables ; Beer, 1 pint.

(Suet Pudding, 10 oz.; Soup, 1 pint;
Bread, 6 oz.; Beer, 1 pint.
Wednesday, The same as Sunday.

Sunday,

Monday,
Tuesday,

25i

Breakfast
Dinner

Thursday,

Friday,
Saturday,

Supper

rRice Pudding, 8 oz.; Bread, G oz.;
\ Beer, 1 pint; Soup, 1 pint.
The same as Sunday.
The same as Thursday.
. Bread, 8 oz.; Cheese, 2 oz.; Beer, 1 pint.

Females.
Tea, 1 pint, with Sugar and Milk ; Bread,

6 oz.; Butter, | oz.
Meat, 6 oz. cooked; Bread, 6 oz. ; Beer,

I pint ; Vegetahles.
Meat Pie, 12 oz. ; Beer, f pint. ; Vegeta-
hles.

, r Suet Pudding, 8 oz, ; Soup, 1 pint ;

Tuesday, | ^read, 6 oz.; Beer, f pint.
Wednesday, The same as Simday.
mi , TRice Pudding, 6 oz.; Bread, 6 oz.;

Ihursday, | Beer, f pint ; Vegetahles.
Friday, The same as Sunday.

Saturday, The same as Thursday.
The same as Breakfast.

Sunday,
Monday,

SUFFOLK.

Day.

Breakfast.

Dinner.

Supper.

Sunday . .

Milk Gruel, and 6 oz.
of Bread each, Oat-
meal 12 lbs. and 6
galls, of Milk for
about 200 Patients.

Males, 8 oz. Bread,
1^ oz. Cheese, and
pint of Beer. Fe-
males, same, except
1 oz. less Bread.

Males, i lb. Bread, f
oz. Butter, and ^
pint Tea. Females,
same, except 1 oz.
less Bread.

MoKDAY . .

Ditto.

Males, 6 oz. Meat, 4
oz. Bread, f pint
Beer ; and Vegeta-
bles. Females, same,
with 1 oz. less Meat.

Males, i lb. of Bread,
1^ oz. Cheese, and
f pint Beer. Fe-
males, same, with 1
oz. less Bread.

Tuesday . .

Ditto.

Soup from Monday,
with additional Meat,
and 6 oz. Bread each.

Same as Sunday.

Wednesday .

Ditto.

Males, Suet Dumpling
of 1 lb. and Females,
one of f lb. with f
pint Beer each.

Same as Monday.

Thursday . .

Ditto.

Same as Monday.

Same as Wednesday.

Friday . .

Ditto.

Same as Tuesday,

Same as Tuesday.

Saturday •

Ditto.

Same as Wednesday,

Same as Thursday.

254

SURREY.

Day.

Breakfast.

Dinner.

Supper.

Monday . .

1 pint of Milk Por-
ridge, with 6 oz. of
Bread for Males, and
4 oz. for Females.

Soup thickened with
harley, peas and
Vegetables, with 6
oz. of Bread.

1 pint of Milk Por-
ridge, with 6 oz. of
Bread, for Males,and
4 oz. for Females.

Tuesday . .

Ditto.

Boiled Beef, 6 oz. free
from bone, with 4 oz.
of Bread, f of a pint
of Beer, and Vegeta^
bles.

Ditto.

Wednesday .

Ditto.

Baked or boiled suet
pudding, 16 oz. for
Males, and 12 oz.for
Females, with ^ of a
pint of Beer.

Ditto.

Thursday

Ditto.

Meat pie with Vegeta-
bles, and f of a pint
of Beer.

Ditto.

Friday . .

Ditto.

Baked Rice pudding
with Treacle.

Ditto.

Saturday . .

Ditto.

Boiled Mutton, &c. as
on Tuesday.

Ditto.

Sunday . .

Ditto.

Boiled or roast Mut-
ton, or Beef, as on
Tuesday.

Ditto.

The Male Patients who work in the garden and farm, as well as those employed as
bricklayers, carpenters, painters, plumbers and glaziers, and in the engine-house, are
allowed for luncheon, bread and cheese, with three quarters of a pint of beer for each ;
and the Females employed in the kitchen and laundry, bread and cheese, with half-a-
pint of beer each ; and the whole of the Female Patients in employment, whether in the
kitchen, laundry, or wards, receive two ounces of tea, eight ounces of sugar, and eight
ounces of butter.

The sick throughout the establishment are dieted at the discretion of the Medical
Officers.

Breakfast
AND Supper

Dinner

YORKSHIRE WEST RIDING.

Milk, 1 gallon ; Water, 2 gallons ; Oatmeal, 2| lbs. ;
Wheat Flotu-, I lb.; of which each Patient is
allowed 1| pint.

Yeast Dumphngs, with Treacle Sauce, and Boiled
Beef or Mutton, with Vegetables, on Sundays, Tues-
days, and Thursdays ; 6 oz. of Meat, free from
bone, allowed for each Patient. Mondays, Wed-
nesdays, and Fridays, Soup made from the Meat

255

boiled the day before; each Patient allowed H pint.
Saturdays, Rice Currie; 2 oz. Rice, 2 oz. Meat,
with Vegetables, for each Patient; each Patient is
allowed | pint of Beer to Dinner.

St. PETER'S HOSPITAL, BRISTOL.

Dinner . . Meat, 4 oz. dressed, without bone, four times a-week;
Peas Soup twice, and BoUed Rice once, with haK-a-
pint of fresh Table Beer each day.

Breakfast . A pint of Milk Porridge (one part Milk and two of
thick Oatmeal Porridge) with Bread ; some of the
Patients have Tea, which is supphed by their friends.

Supper . . Bread and Cheese ; 2 oz. of Cheese and a sufficiency
of Bread: there is generally some left. The Pa-
tients are under medical treatment, &c., and have,
once or twice a week. Roast Meat. The Vegetables
are generally Potatoes ; sometimes Green Vegetables
in the Pea Soup.

Breakfast,

DAILY

Supper

Dinner

PEMBROKE, HAVERFORDWEST.

Milk and Oatmeal Porridge, 2 pints, of which half is
Milk — no Sugar. The Men have Bread in addi-
tion, and the- Women Bread and Butter, about

8 oz. each.

1| pint of Broth, in which Meat has been boiled, and

9 oz. of Bread. The Women are allowed also
\\ oz. of Butter every day, and the Men 3 oz. of
Cheese three times a week each (in addition to the
Broth).

Sunday, Wednesday, and Friday, Meat (generally
fresh), about 5 oz., and li lb. of Potatoes.

Monday, Beef's Head, stewed, 2 pints, (Meat and
Soup together,) and 1| lb. of Potatoes.

256

Tuesday, Two salt Herrings for each, and \\ lb. of

Potatoes.
Thursday, 2\ pints of Rice Milk; 4 lbs. of Rice al-
. lowed for 19 persons, no Bread nor Potatoes.
No Beer is allowed the Patients at any time. — The drink is Water.

PUBLIC SUBSCRIPTION ASYLUMS.

LINCOLN.

MALES.

Breakfast.

Dinner.

Supper.

Bread, 6 oz.

Bread, 3 oz.

Bread, 6 oz.

New milk, boiled,

Meat, cooked and

New milk, boiled, half-

1 pint.

boned, 4 oz.
Vegetables, 10 oz.

pint.

FEMALES.

Bread, toasted, 5 oz.

Bread, 3 oz.

Bread, toasted and

Tea, 1 pint.

Meat, cooked and

buttered, 5 oz.

boned, 4 oz.

Tea, 1 pint.

Potatoes, 10 oz.

•

Sunday . . Roast Beef.

ThWay .^''*^} Boiled Mutton:

Tuesday and\
Friday . . ./

Boiled Beef.

Wednesday and \BoLled Beef; or cold meat warmed with Soup,
Saturday . .) 1 pint, for half the patients.

An Ox cheek is stewed with the soup weekly.

No Beer is allowed.

Carrots are used occasionally instead of potatoes. .

257

NORTHAMPTON.

Solids per Week: —

Males.

Femalei

oz.

Bread, not less than

. 102

102

Solid Meat, cooked, about .

. . 18

Cheese, &c., not less than

. 10

Meat pudding, ditto .

. . 16

Potatoes, about . . .

. 72

Total

. . 218

212

Fluids per Week : —

Milk gruel, about . . « .

. 168

112

Soup, "...

. . 72

Beer (three bushels to the hogshead),

about 112

Tea

. —

Total

. . 352

296

Extra Diet : —

Breakfast, boiled milk

. 16

8—12

Dinner, meat every day

. . 5

Supper " ...

. 5

Bread, instead of vegetables

. . 6

Lunch, bread and cheese

. 5

Beer (at 11 a.m. and 4 p.m.)

. . 8

Sick diet regulated by the necessities of the indivic

uals.

YORK.
There is no regular Diet Table. The Pauper Patients have meat five
times a week for dinner, with bread, potatoes, and other vegetables. For
Breakfast the men have milk and oatmeal ; the women, tea. For Supper
they have bread and cheese, with a pint of beer.

258

METROPOLITAN LICENSED HOUSES.

1.
PECKHAM HOUSE.

DIETARY FOR ^PAUPERS.

Breakfast.

Oatmeal Porridge .
Bread .

rMeat
Sunday, I
Tuesday, ■{ Potatoes
Thursday, I Bread

^Beer

Monday, ^ o
Wednesday, Vg^eL
Friday, J ^^^^aa .

Saturday Irish Stew
Bread

Made chiefly with Milk. No limit to quantity.
Do. do.

Dinner.

160 lbs., or once a fortnight Mutton

180 lbs. for 245 Patients.
No limit to quantity.
Do. do.

1 Pint.

No limit to quantity.
Do. do.

The Soup is made from the liquor in which
the Meat for the whole Establishment
(Private Patients, Paupers, and Servants)
is boiled the previous day, together with
all the bones, with the addition of Barley,
Pease and green Vegetables.

No limit to quantity.
Do. do.

The Stew is made with 60 lbs. Meat, for
250 Patients, with Potatoes, Onions, &c.

Supper.

Bread . . No limit to quantity.
Cheese or Molasses Do.

Beer . . One pint.

Breakfast

EXTRAS TO WORKING PATIENTS.
. Tea and Bread and Butter

-p r Out-door Males . Bread and Cheese, and 1 pint Beer..

a orenoon, <(^ ^ash-house Females, Do. Do. | pint Porter.

Afternoon, . . . Same as Forenoon.

Supper, Females . Tea, and Bread and Butter,

259

Breakfast

Dinner

Supper

HOXTON HOUSE.

. Gruel with Bread. The Patients who are
generally industrious, and those who are
sick, are allowed Tea.

. Meat, (1 lb., including Bone^) and Vege-
tables, varied according to season^ four
days per week. Fresh Mackerel and Her-
rings when in season. Soup three times
per week, made with Meat, Peas, and
Vegetables. Suet, or Rice Puddings, or
Fruit Puddings, when in season, substi-
tuted for Soup occasionally.

. Broth, with Bread, four times a-week.
Bread and Butter, or Bread and Cheese,
three times.
Bread, 18 ounces per day allowed to each

Patient.
Beer given with the Meat Dinners, and with
the Bread and Cheese, or Bread and
Butter Suppers.

BETHNAL HOUSE, BETHNAL GREEN,

Sunday

BREAKFAST.

DINNER.

SUPPER.

1 Pint Gruel,

8 oz. Meat, uncooked, Vegetables and Bread,

Cheese, 2 oz.

5 oz. Bread.

of each ,5 oz.

Bread, 5 oz.

Monday

do.

Rice and Milk. 5 oz. Bread.

do.

Tuesday .

do.

8 oz. Meat, uncooked, Vegetables and Bread,
each 5 oz.

Wednesday

do.

Pudding, 15 oz.

do.

Thursday .

do.

8oz. Meat, uncooked. Vegetables and Bread,
each 5 oz.

do.

Friday . .

do.

Pudding, 15 oz.

do.

Saturday .

do.

8 oz. Meat, uncooked, Vegetables and Bread,
each 5 oz.

do.

Females, as above, 2 Pints of Table Beer per diem for Males, and one for Females.
All Patients occupied in hard labour have Meat daily, and also an allowance of Porter,
varying from half-a-pint to two pints a day.

Sick Diet comprehends Fish, Eggs, Rice, and light Puddings, with the addition of Ale,
Wine, and Brandy, or anything else that the Medical Officer may deem necessary.

S 2

260

PAUPER DIETARIES IN THE FOLLOWING PROVINCIAL
LICENSED HOUSES.

County.

Proprietor.

Asylum.

No.

Devon

Langworthy, R. C .

Plympton House, Plymouth .

Durham . . .

Glenton, Messrs. .

Bensham, Gateshead . .

Kent, S. . . .

Gateshead Fell

Wilkinson, J. E. .

Dunston Lodge, Whickham .

Gloucester . . .

lies, A. . . .

Fairford ....

Hants

Twyman, J. . . ,

Lainston House, Winchester .

Hereford . . .

GiUiland, J. .

Hereford . . . .

Northumberland

Smith&Mackintosh,Mes''s-

Newcastle on Tyne

Oxford .

Mallam, Richard .

Hook Norton . . . .

Salop . . . .

Jacob, James .

Kingsland, Shrewsbury .

Somerset .

Terry, St. .

Bailbrook House, Bath . .

Warwick . . ,

Lewis, Messrs.

Duddeston Hall, near Birm. .

Wilts . ...

Finch, W. . . .

Layerstock House, Salisbury .

Ditto

Finch, W. C. .

Fisherton House

Ditto ....

Langworthy, C. C.

Kingdown House, Box .

Ditto

Phillips, T, .

Belle- Vue House, Devizes

Ditto ....

Willett, R.

Fiddington House

Worcestershire .

Ricketts&Hastings,Mesrs

Droitwich . . - .

York, North Riding .

Martin, James

Gate Helmsley

,, East Riding

Casson, Richard

Hull

The weekly charges for Pauper Patients will be found in the list of Asylums in
Appendix A.

PLYMPTON HOUSE, NEAR PLYMOUTH.

DIETARY.

Breakfast . . . Bread only (without Butter), and Milk

and Water.
The elderly Patients, however, and those
who are not very strong, have Bread and
Butter with their Milk and W^ater.

Supper . : . Same as Breakfast.

Dinner . Monday, ^

Thursday f Boiled Rice, with Salt; Bread and Po-

and C tatoes.
Saturday, )
Tuesday, Pease Soup, with Vegetables and Bread.

261

"Wednesday, Potatoe Pie,

/"Soup made of Beef, with Vegetables,
< Potatoes, and Bread — the Meat is cut
(^ up, and given with the Soup.

(Boiled Beef and Vegetables, and Bread,
no limit.
Milk and Water is given for drink, if
asked for.

Friday,
Sunday

BENSHAM, NEAR GATESHEAD.

Breakfast . . . Boiled Oatmeal and Milk.

The Old and Invalid are allowed Tea.

Dinner . Sunday and \ Boiled or Roast Beef, or Mutton, with
Wednesday, J Potatoes and Bread.

Thurtdl ^""^jCol^ M^^^^' ^''<^*^' ^^'^ Vegetables.

T^ef^y^'^n Irish Stew
Friday, I

Saturday, Fish, or Fruit Puddings

Supper • • Boiled Milk, Oatmeal, and Bread; some-

times Cheese.
The Patients are not limited to a prescribed
quantity, which is regulated according to
circumstances.

GATESHEAD FELL.
Every Morning . Breakfast, Hasty Pudding and Milk.

Sunday

Monday

Tuesday .
Wednesday

Dinner,
Supper,
Dinner,
Supper,

Dinner,
Supper,

Beef and Mutton with Potatoes and Broth,

Rice Milk and Bread.

Barley Milk and Bread,

Boiled Milk with Oatmeal and Bread.

Same as Sunday,

{Fish when it can be procured, or Flour
Puddings with Treacle Sauce.

Same as Monday.

262

Thursday-
Friday
Saturday .

Same as Sunday.

Same as Monday, or Mince and Bread,

Ox Head and Hough Soup, with Potatoes
and Bread. Boiled Milk and Bread for
supper.

All the Working Patients have Meat Din-
ners daily. Old people with the work-
ing Females have Coffee or Tea.

During illness the Diet is ordered by the
Medical attendant.

DUNSTON LODGE, near
GATESHEAD.

MEN PAUPERS. DIET TABLE.

Breakfast

Milk and Hasty Pudding.

Supper .

Milk Gruel with Bread.

Dinner . Monday,

Soup with Meat in it.

Tuesday,

Meat Stew or Suet Dumplings.

Wednesday

, Soup with Meat in it.

Thursday,

Meat Pies or Meat Stew.

Friday,

/Boiled Barley and Milk, Working Men,
\ Meat.

Saturday,

Soup with Meat in it.

Sunday,

Fish, or Meat Pie, or Boiled Beef.

WOMEN PAUPERS.

Supper.

Breakfast

Coffee, Tea.

Dinners

. Same as the Men, or nearly so. Their

Diet is varied as much as possible, and

not stinted in quantity.

263

Breakfast

Supper

Dinner

FAIRFORD GLOUCESTEESHIRE.

Such of the Patients as labour have Ale and
Table Beer mixed, and, occasionally,
Meat for their Breakfast ; and are, more-
over, allov^ed small quantities of Tobacco
and Snuff.
DIETARY.
. Bread and Butter (in the Winter sometimes
Toast and Lard), with Tea and Milk and
Water ; a large round of Bread.

. (Women) Bread and Butter and Tea
(Men) Bread and Cheese ; a large round
of Bread, with 2i oz. of Cheese, and
Table Beer ; some have a pint and some
half-a-pint.

. Meat, generally, every day in the Summer,
with Suet Puddings and Vegetables,
(Potatoes, Cabbage, Peas, or Beans).
The Meat consists of Beef, Mutton,
Bacon, and Pork, and weighs, when
dressed, about 6 or 7 oz. If Bacon
alone, 5 oz. only.
In the Winter, there is always one day
(sometimes, but rarely, two) on which
the Patients have Pease Soup instead of
Meat. On other days, the Dinner con-
sists of one quart of Soup, having the
stewed Meat in it, and Bread — Table
Beer — some have one pint, and some
half-a-pint, as they wish it, at Dinner.
The Patients who work have Table-Beer
and Ale mixed.

September, 1842.

264

6.
LAINSTON HOUSE, WINCHESTER.

DIETARY.

Sunday . Baked Meat, Pudding, and Vegetables.

Monday . Boiled Meat and Vegetables, with Bread.

Tuesday . Baked or Boiled Suet Puddings.

Wednesday Boiled Meat and Vegetables.

Thursday . Ditto Ditto Ditto.

Friday . Ditto Ditto Ditto.

Saturday . Soup with Vegetables, and Bread,

A pint of Table Beer to each Man, daily, and
I of a pint to each Woman, daily. For
Breakfast, the Female Paupers have
Coffee, with Milk, and Bread and Butter,
In the Evenings, Tea and Bread and
Butter. The Pauper Men, for Breakfast
obtain Milk PoFridge or Broth ; in the
Evening, Bread and Cheese, and Beer.

The Diet is the same for the two sexes,
excepting at Breakfast as above specified.

In regard to Epileptic cases, the attendants
are directed to cut less.

7.
HEREFORD LUNATIC ASYLUM.

DIETARY.

Breakfast . . One quart of milk (skimmed) with bread,

or sometimes in the winter, when milk
is scarce, some of the Male Patients
have 1 quart of broth with bread in it.
A few of the women have occasionally
Tea or Coffee, with bread*

265

Supper

Dinner

Bread and Cheese, about 8 or 9^ oz. of
Bread with about 3 oz. of Cheese, (it is
not weighedj) with 1 Pint of Beer. A
few of the women, if invalids or in deli-
cate health, have Tea instead of Beer.

Two days Rice Pudding — a large plateful
not weighed.

Two days Soup and Bread, 1 quart of
Soup with a large piece of Bread.

Three days Meat and Potatoes. It is made
into an Irish Stew, not weighed, no
Bread.

8. ^

NEWCASTLE -ON-TYNE LUNATIC ASYLUM.

DIETARY.
Breakfast . . Milk Gruel, ad lib., with Bread for Break-
fast and Supper.
Dinner . . . 8 oz. of solid Meat with Potatoes, on Sun-
days, Tuesdays, and Thursdays.

Broth, with a proportion of Meat cut up in
it, ad lib., with Bread, on Mondays,
Wednesdays, and Saturdays.

Rice and Milk, ad lib., with Bread, on
Thursday.

The Working Patients are allowed Beer
and have solid Meat daily, with Tea
morning and evening.

Patients advanced in years have also Tea
morning and evening.

The Sick have Diet suitable to their respec-
tive Cases, and Fasting Patients, and
those labouring under peculiar delusions,
have anything they can be persuaded to
take

266

9.
HOOK NORTO^r, OXFORDSHIRE.

DIETARY.

Breakfast . . Bread and Milk, or Broth, or Bread and

Butter and Coffee.

Dinner . Sunday, Boiled Mutton, with Bread and Yegetahles.

Monday, Suet Pudding.

Tuesday, Bacon, with Bread and Vegetables.

„, , J TRice Pudding, with a slice of Bread and
Wednesday, | g^^^^ ^^^ ^^^^ ^^^

{Boiled Beef or Mutton, with Bread and
Vegetables.

Soup with Bread.

{Rice Pudding, with a slice of Bread and
Bacon for the Men.

One pint of Beer is allowed to eaoh Male,
and half a pint to the Females for Dinner,
excepting Soup day.
Supper . . . Bread and Cheese and Beer for the Men.

Bread and Butter and Tea for the Women.

Those who work are allowed Bread and
Cheese and Beer extra.

Thursday,

Friday,
Saturday,

Sunday,
Monday,
Wednesday.
and Friday.

Tuesday,

Thursday

and
Saturday.

10.
KINGSLAND, NEAR SHREWSBURY.

DIETARY.
^ Breakfast . Half a pound of Bread and Milkmeal.
' Dinner . Six ounces of Meat and Potatoes.
hSupper . Half a pound of Bread and Broth (no
' J ^"^ limit).

Breakfast . Half a pound of Bread and Milkmeal.
Dinner . Pease Soup (no limit.)
Supper Half a pound of Bread and Milkmeal.

-i Breakfast . Half a pound of Bread and Broth
VDinner . Eleven ounces of Suet Puddmg and Broth,
/supper . Half a pouiid of Bread and Milkmeal.

The Men who work have Beer; the
Women who work have Tea and Sugar.

267

11.

BAILBROOK HOUSE, BATH EASTON.

DIETARY.

Breakfast .... H pint of Milk, Gruel, or Tea or Coffee, and

5 ounces of Bread as they like, (if Tea or
Coffee, Butter also).

Supper, (Men) 5| ounces of Bread, and 1 ounce of

Cheese, 1 pint of Table Beer.
(Women) have Tea or Coffee, or half-a-pint
of Beer, and 5| ounces of Bread, and 1
ounce of Cheese.
Dinner ..... On Wednesday, Friday, and Sunday, 6

ounces of dressed Meat without bone, and
Yegetables at discretion ; no Bread; 1 pint
of Beer, Men — half-a-pint. Women. '
On Thursday and Saturday, Baked Rice
pudding, I pound before boiled, coarse
Sugar or Treacle, IJ pint of Broth with
Bread in it, no Beer.
On Monday, 1 1 pint of Broth with Bread

in it, and vegetables besides, no Beer.
On Tuesday, Suet Pudding, | of a pound,
Vegetables at discretion; and Beer (one
pint for the Men, half-a-pint for the
- Women).

Patients employed at out of door or in door
labour, have Meat every day, and an extra
meal of Bread and Cheese and Beer, at
eleven o'clock, a.m.

268

12
DUDDESTON HALL, BIRMINGHAM.

DIETARY,
Bbeakfast . . Milk Thickened.

Dinner . . .3 days a week, meat and abundance of vege-
tables.
2 days a week, broth.
I day Pease Soup
Bread and Cheese once a week.
About half a pound of Bread is allowed at
each meal.
Supper . . . Bread and Cheese on Soup and Broth

days ; and on Meat days Milk thickened.
Those who work have an extra meal of
Bread and Cheese, and also Tobacco once
a week.

13.
LAVERSTOCK HOUSE, NEAR SALISBURY.

DIETARY.
Breakfast .... One pint of Skimmed Milk, and about

half-a-pound of Bread.
Occasionally, a pint of Broth and Bread.

Tea One pint of Tea with Bread and Butter, or

half-a-pound of Bread, with 3 ounces of
Cheese, and 1 pint of Table Beer.

Dinner . Wednesday ( ^^°"" *-*° ^ ^^ ^ P^^"*^ ^^ ^°* ^"^* ^'*^^

Friday and
Sunday.

Bread, (i pound) and vegetables, 1 pint
of Table Beer, (on Sundays, Suet Pud-
ding in addition).

Monday
Thursday
and ,
Saturday.

Tuesday | pound of Bread, and 3 ounces of Cheese^

and 1 pint of Table Beer.

Sometimes (in the winter) pease soup, 1|

pint, with as much Bread as they like.

Cold Meat (or cheese), with Bread and
Vegetables, Potatoes and Cabbage, 1 pint
of Table Beer.

269

14.

FISHERTON HOUSE, FISHERTON AUGER, WILTS

DIETARY.

Breakfast (In Summer.) For the Men, 6 to 8 ounces

' of Bread, and 2J ounces of Cheese, one

pint of Table Beer.

(The Bread varies from 6 to 8 ounces, and
depends on the Patient's appetite, and on
the work he performs.)

(In "Winter.) One pint of Broth, made with
Bones, groats and vegetables, &c., and
from 6 to 8 ounces of Bread ; no Beer.

The Women have one pint of Cocoa, with
6 ounces of Bread, and 2 ounces of
Cheese.

Supper Same quantity of Bread and Cheese and

Beer as at Breakfast, for the Men.

One pint of Cocoa, with 6 oxmces of Bread
and 2 ounces of Cheese, for the Women.

Dinner Four ounces of Meat every day, together

with as much Vegetables as they like.
They generally have three sorts of Vege-
tables all the year round, that is to say.
Potatoes, Greens, and Carrots, (or Pars-
nips). They are not allowed any Bread
with their Dinner. Each Patient has one
pint of Table Beer.

The Patients who work are allowed an
extra meal, every day, of Bread and
Cheese, and small quantities of Snuff or
Tobacco are occasionally given to them.

270

15.
KINGSDOWN HOUSE, BOX.

DIETARY.
Breakfast . . . One quart of Gruel, (Milk and Oatmeal),

one-third Milk, and a round of Bread.
Supper . i. Cocoa and Milk and a quart of Broth, with

a round of Bread for the Men.
The Men who work have for eupper Bread
and Cheese and Beer.
Dinner . . . Meat and Vegetables, five times a week,

consisting of Beef, or Bacon, or Mutton,
with Potatoes or Cabbage. — Each Patient
has about 6 oz. of Meat; half-a-pint
of Beer is allowed for Dinner on the meat
days.
On Friday there is boiled Rice with Treacle,

and some Milk in addition.
On Tuesday, a quart of Soup with Bread or
Potatoes ; water only allowed for Dinner
on the Soup and Rice days.
The Men who are at work have Meat,
Vegetables, and Beer, always for dinner.

Breakfast

Supper

Dinner

16.
BELLE VUE HOUSE, DEVIZES.

DIETARY.

. A quart of Milk Porridge (more than one-
third Milk), with Bread cut into slices.

. Bread and Butter, or Bread and Cheese (as
much as they like), with Table Beer — -
more than half-a-pint — or Tea.

. Four days in the week, Meat ; about 4 or 5
oz. of Mutton, Beef, or Bacon, with
Potatoes, Cabbage, or other Vegetables,
with half-a-pint of Table Beer — no Bread.

271

The Beef is sometimes salt and sometimes
fresh. Two days Suet Pudding (no limit),
with half-a-pint of Table Beer. The other
day Bread and Cheese for Dinner (no
limit), and rather more than half-a-pint
of Table Beer.
In the winter the Patients have Pease Soup
once a week, instead of the Pudding ;
about a quart, with Bread in it.

17.

FIDDINGTON HOUSE, WILTS.

DIETARY.
Breakfast . .1 quart of Broth with Bread in it, or 1 quart

of Milk with Bread in it.
Nearly 90 of the Parish Patients are
allowed Tea.
Dinner . . . Meat, five days a week, consisting of about

6 oz. of Beef, Mutton, or Bacon, with
Potatoes, Greens, or other Vegetables;
no Bread ; one pint of Table Beer.
1 quart of Pease Soup with Bread in it, or
On Monday, -^ the same quantity of Broth thickened with

Rice ; 1 pint of Beer.
--V n , , r Bread and Cheese, 8 oz. Bread and 3 oz.
\ Cheese ; 1 pint of Table Beer.
Such of the Patients as work have Ale and
Bread and Cheese at eleven and four
o'clock, making five meals a day ; and for
supper, a pint of Ale extra.

'•(

272

Breakfast

Dinner Sunday,

Monday,
Thursday,
s and

Saturday,

Tuesday,

Supper

18.
DROITWICH.

DIETARY.

Bread and Milk ; Men a quart, "Women a
pint (containing 8 oz. of Bread for the
Men, and 6 oz, for the Women).

8 oz. of boiled Mutton, 1 pound of Pota-
toes, and Beer.

-Soup, a quart, with 8 ozi of Bread.

1 lb. of Suet Pudding for the Men, and
three-quarters of a pound for the
Women, with Beer.

Wednesday "^Eight ounces of boiled Beef, and 1 lb. of

•p, . T j Potatoes, with Beer.

- - - Bread and Cheese and Beer, 8 oz. of
Bread and 1 oz. of Cheese.
If ill, the Patient's Diet is regulated by
the Medical Officer.

19.
GATE HELMSLEY, NEAR YORK.

Breakfast - - Milk and Oatmeal, 1| pint, with Bread

without limit, — Patients who are old, or
in delicate health, are allowed Tea.

Stjpper - - - The same.

DtNN'ER _ - - Five days Meat (twice boiled, and three

times roasted), the roasted Meat is not
weighed, but something short of Jib. is
given to each Patient, — No Bread is
allowed with the Meat (except to old or
Invalid Patients), but Suet Pudding is

273

given, and a variety of Vegetables, with
the Boiled Meat, (which is less in quantity
than the Roasted Meat.) — Soup is served,
and Pudding, filling altogether a pint-
and-a-half vessel.
Two days (Monday and Thursday) there
are Meat Pies, with Potatoes in them : a
large plateful is given, but not weighed.
— No Beer is allowed, except to Invalids
and to Patients who work.

20.
HULL AND EAST RIDING REFUGE, HULL.

Breakfast Men 1 pint of Oatmeal and Milk, and 8 oz. of

Bread.
Women 1 pint of Tea and 8 oz. of Bread.
Dinner Men and Women : —

Sunday, 8 oz. Meat, 14 oz. Potatoes, 1 pint Small

Beer.
Monday, I pint of Soup, 8 oz. Bread.
Tuesday, Ox-head Broth, with Greens, and Barley

and Peas; or,
1 pint of Meat Hash, with Potatoes and

Herbs, and 8 oz. Bread.
Wednesday, Fish, and 14 oz. Potatoes ; or, Pease-Soup

with Bread, and 1 pint of Beer.
Thursday, 8 oz. of Meat, with 14 oz. of Potatoes,

and 1 pint of Beer.
Friday, 1 pint of good Meat and Vegetable Broth,

with 8 oz. of Bread.
Saturday, 1 pint of Rice Frumety, and half-a-pint of

Beer.

274

APPENDIX G.

SCHEDULE 1.

Statement of Criminal Lunatics, April, 1843.

In County
Asylums.

In Licensed
Houses, j

In other

Public

Asylums.

Total.

Tot.

•j-Beds

Chester

Cornwall ....

. ,

Devon

^Durham

Gloucester . . . .

fHants

. .

' Kent

, ,

. .

Lancaster ....

Leicester ....

. .

Norfolk

*Nor\vich . . . .

, ,

, .

Notts

. .

fOxon

. ,

fSalop

+Somerset . . . .

Stafford

Suffolk

•fSussex

, ,

fWarwick ....

. .

fWilts

fWorcester . . . .

York, West Riding .

. .

fDo. East Riding . .

. ,

Bethlem Hospital . .

2]'

Metropolitan District .

Gaols

Totals . . . .

205

257

* Infirmary Bethel, a detached Lunatic Ward of the Union Workhouse.
In the Counties distinguished by a f tlicro arc no County Asylums.

APPENDIX F.

NUMBER OF PAUPER LUNATICS AND IDIOTS CHARGEABLE IN EACH UNION IN ENGLAND AND WALES IN THE MONTH OP AUGUST 1843.

ABSTRACT of RETURNS

,.ho.

ng the

Number of PArPER Ldsatics and I

niOTS chargeable to Parishes compriaed in each Usios in England and Wales, in the Month of Au"ust 1843

each Sex, whether Daogero

lis to themselves or others, where maintained, and the Average Weekly Cost per Head for Maintenance

Clolhing, A'c.

Nombor o

f LunaliM and Idiots chaigeablo to Piiriihei la each Union, id tho MoDth of August 1843.

1 l|

ERE MAI-NtAlNED.

WHEKE MilKlAlNED.

AGES.

Averag* WMkly Cort

™-™'-

•■

~B,

imoT,

"and"

MnlDleMnco^dClotbtng.

o..

UceQHil^naaie.

Onion WorkhouM.

WllhthBlr Friend*.

LiKS

„

Iti

■'•

TolU.

'•

Tow.

''•

Tol.1.

''•

'^°"'

"■

*"•

'"'"■

''-

Tolnl,

—

wart..

ENGLAND;

,. d.

137

20
76

D"",o.t.« ■ ■

190,307
U0J52

129
79

02
32

69
36

131

147

1-10

27
20

53
26

80
40

60
23

9 OJ

S t]

2 6}

8 w\

910!

4 9)

7 0*

2 4

1 4

102

160

3 6J

8 OJ

123

164

■> ni

4 3

127

126

' 4

148

111

206

V'A

7 in

S3I),.M2

112

205

101

187

392

142

115

111

i ii

■s?*

m'.m

119

176

295

133

227

522

225

143

100

8 1

311

340

6 0'

4 ?!

4 71

166

5 7

MiDOLMM

301

441

742

108

120

228

970

191

260

245

241

165

8 91

119

207

121

9 8

103

135

123

258

110

109

" u

2 114

4 111

ui,;iso

8 9)

■i n

11 71

240

110

10 7 ilO 9i

2 61

4 41

So»nin. .

311,413

76
102

135
158

260

150
97

192

452

110
MO

115

199

'77

I35

113
55

135

140

7 4

b"!

2 64
2 lOj

5 4f

442,348

171

2 5

4 H

3U,722

219

167

5 in

2 41

(12,580

147

363

537

8 m

3 3(

7 0(

223,485

105 ,

10 3

9 9

2 lOJ

5 11

w",Z"u«.' ■ ■

220.029
56,469

'?8

110

. '.^

59
8

'0 0*

8 U

2 BJ
2 SJ

4 111

113

165

2-10

114

8 7

386,108

307

9-100

8 Oj

■2 10

5 3J

180,218

183

5 64

180,527

152

8100

ToT«u or ENGLAND

790,751

158

160

318

152

192

344

662

8-100

131

116

101

178

■5

sm"

130
2,050

151

141

123

247

I37

6 OJ

9 9

2 5}

3 1li

18,152,341

3,060

3,873

0.933

3,188

3.494

6,082

13,015

110

1,650

1,839

3,489

1,039

1,218

2,267

1,773

2,200

3,973

1,75

2,138

3.696

2.904

2,95

2,956

2.174

581

3.359

2,421

7 6J

8 11J

2 7i

4 lU

WALES :

Anolkut

38,105

2-10

2 41

2 4t

55,399

1-10

75,136

119

2-10

116

1.5

2 a)

110,404

101

102

1-10

142

86,728

107

149

210

146

■24

08,483

■70

II 9i

04,355

9-100

11 -a

178,041

9-100

50,696

27 75

78.563

T«iii.. ot WALES

19.554

■■>

110

- •

•

229

233

194

1
158

221

9 7

a iij

2 5

2 101

884,173

157

209

300

445

811

1,177

1-10 1; 20

20 ' 21

446

504

1.010

Totiuof59I Unliiiii'

14,030,514

3,217

4,082

7,299

3,554

3,939

7,483

14,792

1-10

1,070

1,855

3,525

1,059

1,239

2,298

1,813

2,250

4,063

2.204

2,702

4,906

991

2,879

3,197

3,188

2,368

1,566

631;

3,466

2,642

7 7

8 Hi

4 9

001 in VdIoi. .

Eillmatca Tormforl
I'.»oi.«i.iin.lW.io;

1,870.315

429

544

973

474

526

999

1,972

15,906.829

3.046

4,626

8,272

4.028

4,404

8.492

10,764

275

SCHEDULE 2.

Cases of Atrocious Offences in County Asylums and Licensed
Houses, April, 1843.

In Li-

County

censed

Beds. . .

CRIME.

Asylums.

CRIME.

Houses.

Murder

Cuttingwithintent »
to do bodily harm J

Chester .

Murder

Arson

I
2

Cornwall

Smothering two "I
Children . ./

••

Devon .
Durham .

Murder .....

Maliciously st:xbbing

Gloucester

Murder

Maliciously cutting

1
1

Hants . .

. .

Murder

Kent . .

Murder

Infanticide ....
Attempting to 1
stab her husband J

I
I

• •

Lancaster

Killing his wife .
Killing his child .
Other Homicides .
Arson

3
1
3

Leicester

Murder of his wife
Arson

1
1

Notts. .

Burning stacks . .

Siilop . .

Arson

Detestable crime .

1
1

Suffolk .

Murder

Manslaughter . .

Sussex .

, .

Maliciously cutiing

Warwick

Murder

Wilts . .

•

Maliciously shooting

YorkW. "1
Riding J

Infanticide ....

. .

YorkE. 1
Riding/

Murder

c •

Murder

Infanticide ....
Shooting his wife .

1
1

2
2

Metrop.
District

Killing his grand- 1
father .... J

Shooting with in- 1
tent to kill . J

Attempt to drown

V ■

Cutting & maiming

INDEX.

Accidents occasioned by disuse of restraint, 147, 148, 149, 151.

Adelaide Fund for relief of Pauper Patients discharged from H;in\vcll ,
27.

Admission of patients into Asylums, 163 — 168 ; law relating to, dis-
regarded as respects Paupers, and evaded as respects Private
Patients, 167.

Allen, Dr., irregularities practised in his House, High Beach, Essex,
36.

Artesian Well, at Han well, 16.

Attendants in Lunatic Asylums should be secured from danger, 150 ;
additional risk to, incurred by diminution of restraint, 151.

Bailbrook House, near Bath, formerly a private mansion, 42 ; im-
provements in, 45 ; steps taken by Commissioners for amendment
of, 67 ; deficient accommodation for exercise at, 135.

Basement stories, use offer patients should be avoided, 22.

Bath, Workhouse at, not licensed, but receives Lunatics, 10, 98.

Bedford Asylum, a County Asylum established under 48 Geo. III.
c. 96, and 9 Geo. IV. c. 40, 9 ; number of Patients at, 16 ;
disadvantages of its situation, ib. ; sleeping cells in, 22 ; irregu-
larity in management of, 25 ; possesses no resident Medical
Officer, 28 ; enlarged twice, 84 ; number of Idiots in, 97 ;
religious observances at, 162, 163.

Belle Grove House, near Newcastle, badly conducted, 40.

Belle Vue House, Devizes, improvements in, 45.

Bensham, near Newcastle, a well-conducted Licensed House receiving
Paupers, 41 ; improvements in, 45.

Bethel Hospital, Norwich, included in class of Public Hospitals, 10
an unlicenced Workhouse, i6. ; to a certain extent an exception
from general rule of Public Hospitals as to patients defraying
their own expenses, 32 ; site of, 33.

Bethlem Hospital ; excepted from operation of 5 & 6 Vic. c. 87, 2 ;
not included in enumeration of Lunatic Asylums, 10; number
of Patients in, 186 ; Criminal Lunatics in, 196.

278

BethDal Green, Asylums at, DonnitorieB in, 13 ; practice at, on discharge
of Pauper Patients, 27 ; situated in Metropolitan district, 43 ;
use of opiates at, 121 ; occupation of Patients at, 131 ; restraint
at, 145 ; accident at, from want of restraint, 149.
Birmingham, Workhouse at, not licensed, but receives lunatics, 10, 98;
want of accommodation for exercise of Insane Patients at, 136.
Bites, by Insane Persons, dangerous effects of, 147, 148.
Bodmin, Asylum, want of water at, 16; defective ventilation, 17'
use of galleries as day rooms, 22 ; yards, 23 ; religious observ-
ances, 162.
Books, use of, in Asylums, 130.
Box, Asylum at, see Kingsdown House.

Bristol, St. Peter's Hospital at, established under special Act, but
included in class of County Asylums, 9 ; bad situation of, 15;
deficient accommodation at, 52, 133 ; totally unfit for an Asylum
for the Insane, 53 ; proposed enlargement of present premises
inexpedient, 65.
Briton Ferry, letter of Welsh parish oflScer to proprietor of Asylum at,

200.
Capper, Mr., Lis evidence as to Criminal Lunatics, 198.
Carisbrooke, House of Industry at, included in class of Licensed Asy-
lums, 10 ; improvements in, 43, 45.
Cells, single sleeping, system of as compared with dormitories, 12, 13 ;

general observations on, 21 ; usual size of, 22.
Chaplains, should be appointed to every Asylum, 160 ; in Public Hos-
pitals and County Asylums, 161, 163.
Chester Asylum, a County Asylum established under 48 Geo. III. c.
96 ; and 9 Geo. IV. c. 40, 9 ; mode of warming, 18 ; irregu-
larity in management of, 26, 45 ; in a crowded state, 83 ;
number of Idiots in, 97; practice as to restraint at, 144; reli-
gious observances at, 161 ; Criminal Lunatic in, 197.
Chevalier, Rev. Dr., irregularities practised in his house at Aspall
Hall, Suffolk, 35 ; persisted in notwithstanding Commissioners*
remonstrances, 38.
Classification of Lunatics, 121 ; beneficial effect of, 122 et seq. ; at
Lancaster, 126 ; at Gloucester, 127; enjoined in Metropolitan
District, 147.
Congenital Idiocy, defined, 108.
Congenital Imbecility, defined, 108.

Cornwall Asylum, united County and Subscription Asylum, esta-
blished under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9, 30 ;
expense at, for Paupers, 31 ; in a crowded state, 83 ; enlarged,
84 ; number of Idiots in, 97 ; Chaplain appointed to, 161.
Cornwall, county of, number of Lunatics in Workhouses and other

places out of County Asylum, 83.
Corporate and Borough towns not authorised to unite with counties in

erection of Asylums, 11, note.
County Asylums : — Regulated by 9 Geo. IV. c. 40, 1 ; several Asy-
lums not erected for County purposes, brought within the Act>

279

2 ; list of those established under 48 Geo. Ill, c. 96, & 9 Geo.
IV. c. 40, 9 ; Asylums established under special Acts included in
class of, ib. ; provisions of Acts establishiag, 10 ; contracts for
purchase of land for, 11; for North Riding of Yorkshire pro-
jected, 11, note; comparative Cost of, 12; use of separate cells
in, ib. ; comfort and advantage of dormitories in, ib., 13 ;
Surrey Asylum, the last erected, 20 ; limitation of size, 23, 24 ;
extent of accommodation afforded by those already erected, ib. ;
formation of rules for, left entirely to Magistrates, 26 ; general
rules for, desirable, ib. ; Resident Medical Officers at, 28, 114;
general remarks on, 29 ; enlargement of, 84 ; insufBcient from
increasing number of incurable cases, 85 ; main object of, cure
of insanity, 88 ; filled with lucurable Lunatics, 87 — 97 ; admis-
sion of Patients into, 93, 165 ; practice in, as to restraint, 143,
144 ; religious observances at, 161 — 163 ; Chaplains at, 161 ;
Reports of, 178, 179, and note.

County Asylums united with Subscription Asylums, erected under
provisions of 48 Geo. III. c. 96, & 9 Geo. IV. c. 40, 9, 30 ;
advantages afforded by, to Pauper Lunatics not equal to those of
County Asylums, ib. ; comparative expense, 31 ; merits of, ib.

County Pauper Lunatics whose Settlements are not ascertained, 91 ;
not included in Returns of Pauper Lunatics, 181.

Craubourne Asylum, irregularities practised at, 39.

Criminal Lunatics, objection to sending them to Asylums, 195 ;
enactments respecting, ib. ; number of, 196 ; nature of their
crimes, ib. ; risk of escape, 197 ; practice respecting at Home
Office, 198 ; case of those becoming sane after committal, ib.;
opinion of Lord Chancellor of Ireland respecting custody of,
199 ; separate care and custody of, highly desirable, ib.

Dancing, use of in Asylums, 139.

Delirium tremens, described, 113.

Dementia, defined, 105.

Denbigh, Asylum about to be erected there, 200, note ; letter from
Medical Practitioner there, 201, note.

Denham Park, non-restraint System practised in Asylum at,"'145.

Derby, Asylum at, formerly a private mansion, 42 ; gross abuses at,
56 ; steps taken by Commissioners for amendment of, 66.

Devizes Asylum, uses of Dormitories in, 13 ; a well conducted
Licensed House receiving Paupers, 41.

Devon Asylum — Plan of, objected to, 29, note.

Devonport, Workhouse at, included in class of Licensed Asylums, 10 ;
deficient in accommodation for exercise, 135.

Diet, sufficient and appropriate, essential in treatment of Lunatics,
118 ; want of, an exciting cause of insanity, 119.

Dirty Patients, separate departments for, in Asylums, necessary, 124 ;
means adopted for their cure, 147.

Dormitoiies, comfort and advantage of, 12, 13; general observations
on, 21.

u 2

280

Dorset Asylum, a County Asylum established under 48 Geo. III. c.
96, & 9 Geo. IV. c. 40, 9 ; inconveniently situated, 15 ; yards
at, 23 ; in a crowded state, 83 ; number of idiots in, 97 ; effect
of improvement of diet on Patients in, 118 ; occupation of
Patients at, 131 ; case of necessary restraint at, 148 ; Chaplain
appointed to, 161 ; religious observances at, 162.

Dorset, County of, number of Pauper Lunatics belonging to, in Work-
houses and other places out of County Asylum, 84 ;

Droitwich, Asylum at, a well conducted Licensed House receiving
Paupers, 41.

Drunkenness, a frequent cause of Insanity, 115; difficulty of deter-
mining on liberation of Patients apparently recovered from
Insanity induced by, 175.

Dryness, importance of in Lunatic Asylums, 16 ; illustrated by case of
Dorset Asylum, 17.

Duddeston, near Birmingham, Asylum at, formerly a private mansion,
42 ; connection of with Workhouses, ib. ; steps taken by Com-
missioners for amendment of, 66 ; Pauper Patients debarred from
sufficient exercise at, 135.

Dunnington, near York, Asylum at, of inferior description, 43 ; escapes
from, 73.

Dunston Lodge, near Newcastle, a well-conducted Licensed House,
receiving Paupers, 41 ; irregularities at, 45 ; improvements in, ib.

Dysentery, prevalent at Dorset Asylum, removed by re-laying the
floors, formerly damp, 17.

England and Wales, Acts relating to Lunatic Asylums in, 1, 2. ;
divided into districts by Commissioners, 4.

Epilepsy, various forms of, described, 110 — 112 ; proportional number
of patients affected by, 112.

Escapes from Licensed Houses, 72, et seq. ; penalty on Officers, &c.
of County Asylums permitting, ib.; of Criminal Lunatics, 197.

Exercise, importance of, in the open air, 129 ; yards and grounds
for, should be provided, 130.

Exeter Asylum, included in class of Public Hospitals, 10 : not fire-
proof, 14 ; sum received at, for Private Patients, in 1842, 32 ;
site of, 33 ; restraint at, 144.

Fairford Asylum, use of dormitories in, 13 ; well conducted, 41 ;
improvements in, 45 ; non-restraint system practised at, 145.

Finch, Dr., irregularities practised in his House, Laverstock, Wilts, 39.

Fisherton, near Salisbury, Asylum at, 42,

Fish Ponds, Asylum at, case of beneficial Restraint in, 149.

Fort Clarence, Military Hospital at, 31.

Galleries used as dormitories, 12 ; warmth and ventilation of, \7 et
seq. ; in St. Luke's Hospital, not warmed, and cold in winter, 20;;
and so at Lincoln, 21 ; use of, as day-rooms, 22 23.

Games, use of, in Asylums, 130.

Gate Helmsley, near York, Asylum at, 43 ; religious observances
at, 161.

281

Gateshead Fell, Asylum at, 43 ; improvement iu, 45 ; case of escape
from, 72, 111, note," 198 ; religious observances at, 161.

Gloucester Asylum, United County and Subscription Asylum establish e d
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9 ; fire at, 14, note
yards at, good, 15, note; mode ofwarming and ventilating, 19,20
arrangement of sleeping-cells in, 21 ; fund for relief of Paupo
Patients discharged from, 27; expense of, for Paupers, 31 ; en-
larged, 84 ; occupation of Patients at, 131 ; non-restraint system
practised at, 140 ; practice as to admission of Patients into, 166.

Great Foster House, near Egham, case of beneficial Restraint at,
148.

Great Wigston, neglect of magistrates in visiting, 68.

Guy's Hospital, Lunatic "Ward in, included in class of Public Hos-
pitals, 10 ; practice at, an exception from general rule of Public
Hospitals, as to patients defraying their own expenses, 32.

Halstock, Dorset, defective accommodation at Asylum there, 40.

Hanwell Asylum, a County Asylum, established under 48 Geo. III.
c. 96, and Geo. I'V. c. 40, 9 ; fire at, 14, note ; disadvantages of
its situation, 15 ; grounds at, spacious, ib. note ; want of water at,
16; defective ventilation at, 17, 20, 22 ; basement stories used
for Patients, 22 ; use of galleries as day rooms, 22 ; yards at,
23, 152; disadvantages of its extreme magnitude, 24 ; proposed
extension of, 25 ; attendants at, ib. ; difficulty of maintaining
order in, ib. ; fund for relief of Pauper Patients discharged from,
27; appointment of Governor at, 28; escapes from, 74; in a
crowded state, 83 ; establishment and subsequent enlargement
of, 86 ; rule for admission into, 87; nearly filled with incurable
Lunatics, 88, 89 ; cost of, 89; table of length of Patients' con-
finement at, 94 ; cost of Patients in, ib. ; eflrect of improve-
ment of diet in, 118 ; non-restraint system practised at, 140 ;
use of solitary confinement at, 147; means adopted for cure of
dirty habits at, 148 ; religious observances at, 163.

Haslar, Naval Hospital at, 31 ; non-restraint system practised at, 140.

Haverfordwest, Asylum at, established under special Act, but included
in Class of County Asylums, 9 ; formerly a gaol, 15 ; possesses
no resident Medical Officer, 28; detail of abuses there, 4.6 et seq. ;
case respecting, laid before Law Officers of the Crown, 51 ; their
opinion, ib. ; wholly unfit for treatment and cure of the
Insane, 52 ; no provision for occupation, amusement, or exercise
of Patients made at, 134 ; number of Patients in, 186.

Hilsea, connection of Asylum at, with "Workhouses, 42 ; steps taken
by Commissioners for amendment of, 66 ; deficient accommoda-
tions for exercise, and want of employment at, 133.

Hook Norton, Asylum at, 42.

Hoxton, Asylum at, 44; deficient in accommodation for exercise, 134;
use of restraint at, 145.

Hull, Workhouse at, established under special Act, but iucluded in
class of County Asylums, 9.

Idiocy congenita], defined, 108.

282

Idiots— returns of numbers by Poor Law Commissioners, 96, 181 ;
mistaken use of the term, ib.; numbers of, in Asylums, 97; often
dangerous, ib. ; large proportion of, in Workhouses, ib. et seq.

Imbecility Congenital, defined, 108.

Insanity, principal forms of, 102 ; causes of, in Paupers, 115, 119;
statistics of, 177 et seq.

Insanity, moral, see Moral Insanity.

Jones, Griffith, a neglected Welsh Pauper Lunatic, case of, 202.

Justices of the Peace, three to be appointed at General Quarter
Sessions, to visit Licensed Asylums in provinces, three times a
year, 2 ; frequently neglect to make regulations directed by
9 Geo. IV. c. 40, 25 ; for Middlesex, do not adjudicate Paupers as
County Patients without investigation, 28; power or duty of, of
visiting Licensed Asylums in Borough-towns, now exercised by
Magistrates of those Boroughs, 67; statement of facts relating to
visits by, 68 ; seldom consider all the points to which Commis*
sioners direct their inquiries, 69 ; visits of, not sufficient to put
down abuses, 70 ; have charge not only of County Asylums but
all Pauper Lunatics, 85 ; Visiting Justices to examine Orders
and Certificates, 164 ; mode of exercising their power of libera-
tion, 171.

Kent JAsylum, a County Asylum established under 48 Geo. III.
c. 96, and 9 Geo. IV. c. 40, 9 ; well conducted, 15 ; detached
Infirmaries at, ib. note; well ventilated, 17; mode of warming

■ and ventilating, 19 ; use of galleries as day rooms, 22 ; yards at,
23 ; extent of accommodation at, ib. ; enlarged, 84 ; number of
Idiots in, 97 ; occupation of Patients at, 131 ; practice as to re
straint at, 144.

Kingsdown House, at Box, near Bath, bad condition of, 59 ; steps
taken by Commissioners for amendment of, 67 ; deficient accom-
modation for exercise at, 135 ; excessive restraint practised at,
139.

Kingsland,*near Shrewsbury, House of Industry at, included in class
of Licensed Asylums, 10.

Labour of Patients ought not to be reckoned on as a source of profit,
129.

Lainston, Hants, Asylum at, formerly a private mansion, 42 ; bad
state of, 57 ; steps taken by Commissioners for amendment
of, 66 ; excessive restraint practised at, 139.

Lancashire, burdened with unusual number of Paupers whose settle -

ments are not ascertained, 91.
Lancaster Asylum, a County Asylum established under 48 Geo, III. c.
96, and 9 Geo. IV. c. 40, 9 ; inconveniently situated, 15 ; detached
infirmaries at, ib. note ; want of water at, 16 ; number of Patients
in, ib. ; arrangement of sleeping cells in, 21 ; yards at, 23 ; enlarge-
ment of, [25, 84 ; crowded state of, 83, 90 ; accumulation of
Incurable Patients at, 93 ; suicidal Patients in, 61 ; associated
with the cheerful, 125; cases of suicide there, it. note; classifica-

283

tion at, 126 ; waut of employment for Patients at, 135; non-
restraint system practised at, 140 ; means adopted for cure of
dirty habits at, 148 ; religious observances at, 162.

Laverstock, improvements in Asylum at, 45.

Leicester Asylum, united County and Subscription Asylum established
under 48 Geo. III.c. 96, and 9 Geo. IV. c. 40, 9, 30 ; number of
Patients at, 16 ; disadvantages of its situation, ib, ; mode of
warming and ventilating, 18 ; yards at, 23 ; expense of, for Pau-
pers, 31 ; enlargement of, 84 ; deficient accommodation for
exercise at, 133; religious observances at, 162; irregularity in
admission of Patients into, 165.

Leicester, Workhouse at, not licensed, but receives Lunatics, 10^ 97.

Liberation of Patients, 168 ; plan of gradual, suggested, 169 ; Commis-
sioners not empowered to grant partial liberty, ib. ; difficulties
attending, 170; Patients should be examined by competent
persons previous to, 171 ; irregularities practised in respect of,
171 — 173; power of, should be vested in some persons under
sanction of the legislature, 176.

Licensed Asylums, regulated by 2 & 3 Will. IV. c. 107, and 5 & 6
Vic. c. 87, 2 ; number of, 3 ; parts of Workhouses included in
this class, 10 ; use of dormitories in, 13 ; two only built fire-
proof, 14 ; appointment and dismissal of servants in Provincial
Asylums vested in visiting Magistrates, 25 ; irregularities in, 25
et seq. and 35 et seq. ; resident Medical Attendants at,
28, 113; various descriptions of, 34; general remarks on,
ib. et seq. ; nervous Patients ought not to be received in, 37 ;
general remarks on those receiving Paupers, 41 et seq. ;
alterations required in houses formerly private mansions, 41 et
seq, ; tenure of, frequently stands in the way of improvement,
45 ; improvements in several, ib. ; improper practices in, ib. ;
abuses and defects, 46 et seq. ; escapes from, 72 et seq. ; Medical
treatment in, 115; allowance of food to Patients in, 118;
smaller, often cold and damp, 120 ; practice in, as to restraint and
non-restraint, 145 — 154 ; religious observances at, 160, 161 ;
order and certificates required for admission of Patients into,
163, 164 ; different for Private and Pauper Patients, 165 ; pro-
prietors of, often receive private patients in lodgings irregularly,
167 ; returns required from proprietors of, 180 ; number of Welsh
Pauper Lunatics in English Asylums, 200.
Licenses, additional caution in granting, advisable, 70 ; in Metropolitan

distiict granted by Commissioners, ib.
Lincoln Asylum, included in class of Public Hospitals, 10; use of
dormitories in, 12; mode of warming and ventilating, 21 ; sum
received at, for Private Patients, in 1843, 32 ; number and cost
of Pauper Patients in 1843, ib.\ site of, 33; prohibition of
admission of heated air to the galleries at, 120; use of opiates
interdicted at, 121 ; non-restraint system practised at, 140 ;
religious observances at, 163.

284

Liverpool Asylum, ineluded in class of Public Hospitals, 10 ; restraint
at, 144.

Loddon, Norfolk, bad condition of licensed House at, 40 ; somewhat
improved on Commissioners, last visit, ib. note.

Lord Chancellor of England, power given to, by 5 & 6 Vic. c. 87, 2-

Lord Chancellor of Ireland, his opinion as to custody of Criminal
Lunatics, 198.

Lunacy, disease of, essentially different from other maladies, 92 ; sug-
gestions for amendment of law concerning, 204 et seq.

Lunatic Asylums, Commissioners authorised to inspect, throughout
England and Wales, 1 ; statutory provisions respecting, 2 ; num-
ber of, 3 ; various degrees of merit and defect in, 6 ; different
classes of, 9 ; Corporate and Borough towns not authorised to
unite with Counties in erection of, 11, note ; for Paupers, question
•whether they should be made fire-proof, 14 ; proper site for,
14, 15 ; importance of warmth, ventilation, and dryness at, 16;
state of ventilation at, various, 17 ; should have cheerful and
spacious day-rooms, 22 ; diminution of restraint in, 24 et seq ;
difficulty of finding good attendants in, 25 ; difficulty of main-
taining order in large, ib. ; Mania and Dementia prevail-
ing forms of Insanity in, 105; medical treatment in, 113
et seq. ; occupation, amusements, and exercise of Patients in,
128 et seq. ; deficiency in respect to employment in many, 132 ;
practice regarding Restraint in, 137 et seq. ; safety of attendants
in, should be secured, 150 ; religious observances at, 159 — 163 ;
instances of sane persons being sent to, very rare, 176; confine-
ment in, frequently too much prolonged, ib. ; power of liberation
from, should be vested in some persons under sanction of the legis-
lature, 176 ; suggestions as to keeping registers and medical books
in, 179 ; Criminal Lunatics in, 195 et seq. ; in Wales, 200, and
note ; number of Welsh Pauper Lunatics in English, ib.

Lunatics, number of, in England and Wales, 7 ; more than two-thirds
maintained at the public expense, ib. ; dirty, importance of free
Ventilation to, 17 ; proper objects of inquiry concerning, 69 ;
position of such as have not been subjects of Commission, with
respect to their property whilst confined in Asylums, 76 et seq. ;
proportion of cures when admitted into Asylums within three
months of attack, 80 ; great importance of removing to Asy*
lums as soon as possible, 81, 93 ; curable, generally recover
withiu first year, 93 ; causes of increase in number of incurable,
100 ; medical treatment of, 113 et seq. ; suffer from cold, 120 ;
classification of, 121 ; occupations, amusements, and exercise of,
128 etseq. ; labour ofj ought not to be reckoned on as a source of
profit, 129 ; admission and libeftstion of, 163 ; different certifi-
cates required for Private and Pauper, 165, 166 J law as
respects order and certificates, on admission of, disregarded and
evaded, 167 ; liberation of, 168 ; should be examined previous to
liberation, 171; power of liberating should be vested in some

285

persons under sanction of the legislature, 176 ; erroneous opinions
as to numbers of, 177 ; statistical tables of numbers and con-
dition of, 184, 185 ; proportion of curable Patients, 187 ; table
of cures and deaths of, 189 ; total number in England and
Wales, 190—194.
Lunatic Poor, especial inquiries concerning, 6 ; Asylums for reception
of, filled with incurable Patients, ib. ; large number received in
unlicensed Workhouses, 10 ; importance of out-door occupation
for, 16, 128 ; general rules for relief of when discharged, desir-
able, 26, 28 ; practice on discharge of, at Bethnal Green, 27 ;
number discharged from Lancaster and Middlesex Asylums, ib. ;
funds for relief of, when discharged, ib. ; construction and cost of
Asylums for, a matter of national interest, 30 ; comparative ad-
vantages afforded to, by County Asylums, and Asylums partly
supported by contributions, 30 ; charges for, in Public Hospitals,
32; Licensed Houses receiving, 34; Licensed Houses particu-
larly devoted to reception of, 41 ; treatment of, in Licensed
Houses, formerly private mansions, ib. et seq. ; proper objects of
inquiry concerning, 69 ; should not be sent to Asylums at a great
distance, 75 ; visits of friends to, ib. ; usually detained in Work-
houses or elsewhere long after first attack of mental disease, 80 ;
causes of detention of, from Asylums, 81 ; want of accommo-
dation for, 82 et seq. ; returns of to be made to Quarter Ses-
sions, 85 ; no means taken for early admission of, into Asylums,
86 ; number of in Middlesex for whom there is no room in
County Asylum, 87, 89; number admitted to Marylebone
Workhouse, 87 ; illegality of detaining recent cases in Work-
houses, 88 ; number unprovided for in Lancashire, 90 ; in Surrey,
91 ; whose settlements have not been ascertained, ib. ; erection
of places of refuge for incurable, recommended, 92; admission of
into Asylums, 93 ; cost of in Hanwell, 94 ; in Workhouses, 98
et seq. ; excess of suicidal cases among, 107, note; causes of
insanity of, 115 ; medical treatment of, 115—117 ; diet of, 118;
insufficient means of exercise afforded to, in Workhouses, 136;
certificate required on admission of, into County and Licensed
Asylums, 166 ; law respecting wholly disregarded, 167 ; subject
to unjustifiable restraint, ib. ; returns of, 178, 181 ; maintained
at charge of County, not included in returns, 131 ; proportion per
cent of, to population, 193 ; neglected state of in Wales, 199 et
seq.

Manchester Hospital, included in class of Public Hospitals, 10 ; site
of, 33.

Manchester, Workhouse at, not licensed, but receives Lunatics, 10.

Mania, defined, 103 ; acute, ib. ; chronic, 104 ; intermittent, ib. ;
recurrent, 105.

Market-Lavingtou Asylum, use of dormitories in, 13 ; well-conducted
Licensed House, receiving Paupers, 41.

Marylebone Workhouse, number of Pauper Lunatics in, 87.

286

Medical Attendants, to be appointed at General Quarter Sessions to
visit Licensed Asylums in provinces three times a year, 2 ;
general high character of, 8 ; at Hanwell, their onerous duties,
24 ; at Licensed Asylums, 28, 113 ; in Coiinty Asylums, ib.;
at St. Peter's Hospital, Bristol, 53 ; generally visit pauper patients
regularly, 74; opinions of, as to treatment of Insanity, 115 —
117; as to restraint, 153, 156 — 159; as to tranquillising effect
of religious services, 160.

Medical Journal, neglect in lieeping, 40.

Medical treatment of Patients in Lunatic Asylums, 113; difference
prevailing as to, in different classes of Asylums, ib. ; opinions of
Medical Attendants in Asylums respecting, 116, 117; regulations
of, in some Asylums at variance with general opinion, 118 ; not
substituted for coercion, 121.

Melancholia, defined, 106.

Metropolitan Commissioners in Lunacy, authorised to inspect public
and private Asylums throughout England and Wales, 1 ; to visit
Licensed Asylums in Metropolitan district four times a year, 2 ;
to visit and report on Licensed Asylums in the Provinces twice a
year, ib. ; and County and other Asylums under 9 Geo. IV.
c. 40, once a year, ib. ; directed by Lord Chancellor to visit Royal
Naval and ^lilitary Hospitals, and all other public Asylums except
Bethlem, ib. ; divide England and Wales into four districts, 4;
each again subdivided into two parts, ib. ; inquiries instituted by
them ib. et seq. ; especially as regards Lunatic poor, 6 ;

, recommendation of, as to Medical Officers, 28 ; exposure
of main evils chief object in present Report of, 34 ; former!)'
prosecuted a person for improperly receiving Insane persons as
boarders, 38 ; their reasons for continuing licenses to the Asylums
at Peckham and Hoxton, 44 ; proceedings of, with respect to
Asylum at Haverfordwest, 50 et seq. ; endeavours used by them
to correct abuses, 65 et seq. ; visits of, to Workhouses, 98 ; extract
from Report of, on Norfolk Asylum, 114; not empowered to
grant partial liberty to Patients, 169 ; inquiries of, as to Statistics
of Insanity extended to Scotland and Ireland, 178.

Middlesex Asylum. — See Hanwell.

Middlesex, County of, burdened with unusual number of paupers whose
settlements are not ascertained, 91.

Middleton, Lady, fund instituted by, for relief of Pauper Patients dis-
charged from Nottingham Asylum, 27.

Military and Naval Hospitals, Commissioners authorised to visit, 2 ;
number of, 3 ; supported by and under control of Government,
10 ; at Fort Clarence, 31 ; at Haslar, ib.

Monomania, defined, 106.

Moral Insanity, defined, 106.

Morda, near Oswestry, House of Industry at, included in class of
Licensed Asylums, 10 ; ill-suited for reception of Patients, 143.

Morecroft House, case of beneficial restraint at, 149.

287

Music, use of in Asylums, 130.

Nervous Patients, ought not to be received in LicensedHouses, 37 ; their
admission into such houses without certificates contrary to law, 38.

Newcastle Asylum, a well-conducted Licensed House receiving Pau-
pers, 41 ; case of dangerous Lunatic at, 174.

Norfolk Asylum, a County Asylum established under 48 Geo. III.
c. 96, and 9 Geo. IV. c. 40, 9 ; number of Patients at, 16 ; dis-
advantages of its situation, ib. ; yards at, 23 ; possesses no resi-
dent Medical Officer, 28 ; want of medical attendance at, 114 ;
deficient accommodations for exercise at, 134.

Northampton Asylum, included in class of Public Hospitals, 10; not
fire-proof, 14 ; sum received at, for Private Patients, in 1-342,
32 ; number and cost of Pauper Patients in, 1843, ib. ; site of,
33; suicidal propensity in Patients at, 107 ; prevails in Pau-
per part of establishment, ib., note ; non-restraint system prac-
tised at, 140 ; religious observances at, 163 ; irregularity in admis-
sion of Patients, 165.

Northumberland House, accidents at, from want of restraint, 149.

Norwich Asylum, see Bethel Hospital.

Nottingham Asylum, United County and Subscription Asylum, esta-
blished under 48 Geo. III. c. 96, & 9 Geo. IV. c. 40, 9, 30 ; badly
situated, 15 ; mode of warming, 18 ; basement stories used for
Patients, 22 ; unfit for Invalids, ib. ; yards at, 23 ; fund for
relief of Pauper Patients discharged from, 27 ; County Asylum
partly supported by contributions, 30 ; expense of, for Paupers,
41 ; enlarged, 84 ; substitution of recent for old cases at, 93 ;
want of employment for Patients at, 134 ; restraint at, 144.

Non-restraint, system of, 140 et seq.

Nunkeeling, Asylum at, bad state of, 64 ; escape from, 73, 197 ;
excessive restraint practised at, 139 ; religious observances ut,
161 ; irregular liberation of Patients from, by Justices, 172.

Nursling, Hants, Asylum at, formerly a private mansion, 42 ; insuf-
ficient accommodation for Paupers at, 58 ; steps taken by Coni-
sioners for amendment of, 66.

Occupation, amusements, and exercise of Lunatics, 16, 128 et seq.

Ogilvie, Mr., irregularities practised in his House, Calne, Wilts, 37 ;
persisted in notwithstanding Commissioners remonstrances, 38.

Opiates, use of in Lunatic Asylums, 120.

Order and Certificates required for admission of Patients, not Paupers,
into Licensed Houses, 163 ; not required by statute in Public
Hospitals, 164 ; required by private regulations, ib. ; desirable
in all cases, 165 ; different for Private and Pauper Patients, ib. ;
disregard and evasion of the law respecting, 167 ; object of
law in requiring, ib.

Oulton, neglect of magistrates in visiting, 68.

Out-door occupation, importance of to Insane Poor, 16, 129.

Paralysis of the Insane described, 109.

Pauper Asylum, Cork, 178.

Pauper Lunatics, see Lunatic Poor.

288

Peckham, Asylum at, 43 ; diet at, insufficient, 44.

Phillips, Mr., restraint at his Asylum near Devizes, 151.

Philp, Dr., accident at his house from -want of restraint, 151,

Plympton, Asylum at, formerly a private mansion, 42 ; disgraceful
condition of, 60 — 63 ; complaints of Visiting Justices disre-
garded, 60 ; Commissioners' former Report on, quoted, 62 ; steps
taken for its amendment, 65 ; escape from, 73, 197 ; excessive
restraint practised at, 139.

Poor Law Commissioners — their regulations regarding detention of
Lunatics in Workhouses, 95 ; returns by, of number of Pauper
Idiots, 96.

Private Patients in Licensed Houses frequently sleep in dormitories
containing several beds, 13; in reduced circumstances derive
benefit, at a moderate cost, from Public Hospitals, 32 ; visits of
friends to, 75 ; often received in lodgings irregularly, 167 ; re-
turns of, required, 182.

Property of Lunatics, not subjects of Commissions, cases respecting,
76 et seq., 78, note ; suggestions for protection of, 78.

Public Hospitals, supported wholly or in part by voluntary contri-
butions, enumerated, 10 ; at Northampton and elsewhere not
fire-proof, 14 ; appointment of Resident Medical Officers at, re-
commended, 28 ; Patients in, pay the greater part, and sometimes
the whole of the expenses of their maintenance and medical atten-
dance, 32 ; exceptions, ib.; sums received by from Private Patients,
ib. ; claim of some governing bodies to exemption from visitation,
33 ; practice as to restraint in, 143 ; religious observances at, 161

J — 163 ; Orders and Certificates not required by statute for
admission of Patients into, 164 ; not subject to visitation, ib.\
private regulations require Certificates, ib. ; irregularities in
admission of Patients into, 165 ; Reports of, 178.

Radcliffe Asylum, now called the Warnefurd Asylum, 10.
Redruth, Workhouse at, not licensed, but receives Lunatics, 10, 98,

Refuge near Hull, provisions for exercise at, deficient, 135 ; case of

irregular removals from by Parish Officers, 173.
Religious Services and Instruction, proper attention to, generally paid,

459 ; tranquillising effect of, ib.
Restraint, diminution and disuse of, in Asylums, 24 ; difficulty of
maintaining order in large establishments, in absence of, 25 ;
unnecessary practised at Kingsland, near Shrewsbury, 43 ; prac-
tice of, at Haverfordwest, 48 ; at Bristol, 53 ; at West Auckland,
54 ; at Wreckenton, 55; at Lainston, 58; at Kingsdown, near
Bath, harsh and cruel, 59; at Plympton, 60— 63 ; at Nun-
keeling, 73; at Licensed House in Yorkshire, 73 ; not a proper
remedy against escape, except in very violent or dangerous eases,
74 J various practices in respect to, 137 ; relative advantages of
restraint and non-restraint, 138 ; not permitted in well-managed
Asylums, except in extreme cases, 139 ; practice as to, in Public
Hospitals aud County Asyhmis, 143 ; Licensed Houses, 145 —

289

154 ; opinions of Medical Superintendents as to, 152 ; arguments
for and against the disuse of, 156; cases of unjustifiable, 167.

Retreat at York, included in class of Public Hospitals, 10 ; sum re-
ceived at, for Private Patients, in 1842, 32 ; internal accommo-
dations, &c. 33 ; system of managing Insane at, 138 ; restraint
at, 143.

Ringmer, near Lewes, Sussex, defect in management of Asylum at, 39.

St. Asaph, Dean of, his letter on the state of Pauper Lunatics in
Wales, 201.

St. Austle, Workhouse at, woman in raving mania found in, 83.

St. Luke's Hospital, included in class of Public Hospitals, 10 ; galle-
ries in, not warmed, 20 ; ventilation imperfect, ib. ; assistance
given to poor Patients on discharge from, 27 ; sum received at,
for Private Patients, in 1842, 32 ; site of, 33 ; regulations of, ib. ;
average of cures at, in 1842 and 1843, 81 ; restraint at, 144 ;
former neglect of religious observances at, 163; practice as to
admission of patients into, 166.

Sandfield, Asylum at, escape from, 73.

Sheffield, Workhouse at, not licensed, but receives Lunatics, 10.

Solitary confinement, a register of its application should be kept, 146 ;
no protection against dirty habits, 147.

Stafford Asylum, united County and Subscription Asylum established
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9, 30 ; use of
dormitories in, 12 ; arrangements at, much approved, 15, note ;
expense of, for Paupers, 31 ; in a crowded state, 83 ; religious
observances at, 162.

Statistics of Insanity, 177 et seq.

Statutes referred to :

39 & 40 Geo. III. c. 94 ; 195, 196.
48 Geo. HI. c 96 ; 9, 10, 11, 30.

9 Geo. IV. c. 40; 1, 2, 9, 10,11 and note, 25, 30,72, 85,
164, 179 and note, 181, 187 and note.

2 & 3 Will. IV. c. 107 ; 2, 28, 40, 67, 114, 128, 164, 166,

169, 179 note, 180, 182.

3 & 4 Will. IV. c. 64, ss. 3, 4 ; 180.
3 & 4 Vic. c. 54 ; 195, 196.

5 & 6 Vic. c. 57 ; 181.

5 86 6 Vic. c. 84 ; 79.

5 & 6 Vic. c. 87 ; 1, 2, 79,97, 121, 128, 169, 179, note, 180.
Stoke Damerell, ill suited for reception of patients, but well managed,

43.
Subscription Asylums, see Counly Asylums united, ^c. and Public

Hospitals.
Suffolk Asylum, a County Asylum established under 48 Geo. III. c.

96, and 9 Geo. IV. c. 40, 9 ; basement stories of, used for Patients,

22; in a crowded state, 83 ; non-restraint system practised at,

140, 142 ; religious observances at, 163.

290

Suggestions for the amendment of the law relating to Lunacy, 204 et
ieq.

Suicide, propensity of melancholy Patients to, 107 ; statistical state-
ment of Patients inclined to, at Northampton and Lancaster, iJ.;
propensity to prevails chiefly in Pauper part of establishment at
Northampton, ib. note ; classification of Patients inclined to, 124 ;
cases of at Lancaster, 125, note.

Surrey Asylum, a County Asylum established under 48 Geo. III. c. 96,
and 9 Geo. IV. c. 40, 9 ; great expense in making fire-proof, 14,
note; merits of, 15; well- ventilated, 17; the last erected, 20 ;
mode of warming and ventilation, ib. ; galleries in, 21 ; basement
stories used for Patients, 22, 84 ; means used to render them
cheerful, 22 ; extent of accommodation at, 23.

Swift's Hospital, Dublin, 178.

Taylor, Mr., case of beneficial restraint at his Asylum near Bri8tol,149.

Tuke, Mr., his opinion as to the necessity of a vigorous supervision of
all Asylums, 71, note.

Ventilation, importance of, in Lunatic Asylums, 16 ; state of in
various Asylums, 17 ; results of inquiries respecting, 18 e< seq.

Visiting Commissioners, returns by, 180.

Visiting Magistrates, in Middlesex, system pursued by, 88 — 90.

Visits of friends to Lunatics often interdicted by parties authorising
their detention, 76.

Wakefield Asylum, yards at, 23 ; fund for relief of Pauper Pa-
tients discharged from, 27 ; occupation of Patients at, 131 ;
restraint at, 144.

Wales, neglected state of the Insane in, 199 ; number of Pauper
Lunatics in, 200; state of Pauper Lunatics described in letter by
the Dean of St. Asaph, 201 ; in letter from Medical Practitioner
at Denbigh, ib. note ; cases at Carnarvon, 202.

Wnrmth, importance of in Lunatic Asylums, 16, 119 ; of galleries and
dormitories, 17 ; results of inquiries respecting, 18 ef seq.

Warneford Asylum, included in Class of Public Hospitals, 10; sum
received at, for Private Patients in 1842, 32 ; site of, 33 ;
restraint at, 144 ; religious observances at, 163.

West Auckland, Asylum at, bad state of, 53 ; recorded opinion of
Visiting Magistrates regarding, 54; totally unfit for a Lunatic
Asylum, 55 ; steps taken by Commissioners for amendment of,
66 ; want of employment for Patients at, 133 ; excessive re-
straint practised at, 139.

West Mailing, concealed sleeping places discovered at, 64.

Whitmore House, case of necessary restraint at, 147.

Workhouses, those of which parts are licensed, enumerated, 10 ; many
not licensed receive large numbers of Insane Persons, ib.', con-
nection of with Licensed Asylums, 42 ; Poor Law Commissioners*
direction regarding detention of Lunatics in, 95 ; detention of
Lunatics in, 98 — 101 ; deficient accommodation for exercise of
Insane Patients in, 136.

291

Wreckentou, bad state of, 55 ; unfit for an Asylum, 56 ; stops
taken by CommissionerB for amendment, 66; excessive restraint
practised at, 139.

Yards of Asylums, proper construction of, 23.

York Asylum, included in class of Public Hospitals, 10 ; not fire-
proof, 14 ; fire at, 14, note ; restraint at, 144.

Yorkshire, Asylum for West Riding of, a County Asylum established
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9 ; among the
best, 15 ; extent of accommodation at, 23 ; in a crowded state,
83 ; enlarged, 84; substitution of recent for old cases in, 93.

THE END,

LONDON :
BRADBURY AND EVANS, PRINTERS, WHITEPRFARS.

Deposited by the BOSTON ATHEN^UM

IN THE LIBRARY OF THE

25o^ton Sl^cliical %matp ^^-^ociation,

BY AUTHORITY OF THE TRUSTEES.

^2rrr..,.e^,_

lihrarian.

t!^e-c€>iZ'^-^

COUNTWAY LIBRARY OF MEDICINE

G7 G79